title: Induction chemotherapy for unresectable urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  • To analyse the outcome in selected patients with initially unresectable or minimally metastatic muscle-invasive urothelial bladder cancer who underwent induction chemotherapy (IC) followed by radical cystectomy (RC).
  
  
  METHODS
  • Thirty patients with initially unresectable, locally advanced or minimally metastatic bladder cancer underwent platinum-based IC followed by RC with curative intent at our institution from 2000 to 2007. • They received a median of four cycles (range 2-6 cycles) of cisplatin and gemcitabine (n= 19), carboplatin and gemcitabine (n= 9) or other platinum combinations (n= 2). • We retrospectively analysed all 30 patients for complete pathological remission (pT0), disease free survival (DFS) and overall survival (OS). Chi-square tests, Kaplan-Meier analyses, and Cox univariate modelling were used.
  
  
  RESULTS
  • Before IC, 30 patients were deemed unresectable because of locally advanced tumour classification (cT4, 18/30) and/or clinically suspected lymph node (LN) metastasis (21/30) or suspected distant metastasis (3/30). • At re-staging after IC there was a complete regression of all enlarged LN in 16/21 patients, a partial LN response in one patient or stable LN size in the remaining four patients. • After RC, 9/30 (30%) of patients had attained pT0. • The median follow-up was 28 months (range 4-97 months). The 5-year DFS and OS rates were 42% and 46%, respectively, for all patients. • In the pT0 patients, the DFS (83%) and OS (71%) rates were significantly higher than in non-pT0 patients.
  
  
  CONCLUSIONS
  • Patients undergoing IC followed by RC showed encouraging response and survival rates, suggesting that selected patients with initially unresectable bladder cancer benefit from this combined regimen.
authors.affiliation: Department of Urology, University Hospital Bern, Bern, Switzerland.
authors.forename: Pirus
authors.initials: P
authors.lastname: Ghadjar
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Burkhard
authors.forename: Oliver
authors.initials: O
authors.lastname: Gautschi
authors.forename: George N
authors.initials: GN
authors.lastname: Thalmann
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012074:Remission Induction / Q000379:methods; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D016190:Carboplatin; D002945:Cisplatin; D000093542:Gemcitabine