Induction cisplatin and fluorouracil-based chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer.
OBJECTIVE
To evaluate a multimodality bladder-preserving therapy in patients with muscle-invasive bladder cancer.


METHODS
Patients with stages T2-4aN0M0 bladder cancer suitable for cystectomy underwent radical transurethral resection and induction chemotherapy, followed by concurrent chemoradiotherapy (CCRT). Patients with a Karnofsky performance status (KPS) <80 or age > or =70 years underwent Protocol A: induction chemotherapy with three cycles of the cisplatin and 5-fluorouracil (CF) regimen, and CCRT with six doses of weekly cisplatin and 64.8 Gy radiotherapy given with the shrinking-field technique. Patients with KPS > or =80 and age <70 years underwent Protocol B: induction chemotherapy with three cycles of weekly paclitaxel plus the CF regimen, and CCRT with six doses of weekly paclitaxel and cisplatin plus 64.8 Gy radiotherapy. Interval cystoscopy was employed after induction chemotherapy and when radiotherapy reached 43.2 Gy. Patients without a complete response (CR) were referred for salvage cystectomy.


RESULTS
Among 30 patients (median, 66 years) enrolled, 17 and 13 patients underwent Protocol A and B, respectively. After induction chemotherapy, 23 patients achieved CR. Five (17%) of 7 patients without CR underwent salvage cystectomy. Overall, 28 patients (93%) completed the protocol treatment. Of 22 patients who completed CCRT, 1 had recurrence with carcinoma in situ and 3 had distant metastases. After a median follow-up of 47 months, overall and progression-free survival rate for all patients were 77% and 54% at 3 years, respectively. Of 19 surviving patients, 15 (79%) retained functioning bladders.


CONCLUSIONS
Our protocols may be alternatives to cystectomy for selected patients who wish to preserve the bladder.
Lin
Chia-Chi
CC
Department of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
Hsu
Chih-Hung
CH
Cheng
Jason C
JC
Huang
Chao-Yuan
CY
Tsai
Yu-Chieh
YC
Hsu
Feng-Ming
FM
Huang
Kuo-How
KH
Cheng
Ann-Lii
AL
Pu
Yeong-Shiau
YS
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage; D002985:Clinical Protocols; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D015653:Cystectomy; D004334:Drug Administration Schedule; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D017239:Paclitaxel / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D012074:Remission Induction; D016879:Salvage Therapy; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil