title: Whole-pelvis or bladder-only chemoradiation for lymph node-negative invasive bladder cancer: single-institution experience.
abstract: OBJECTIVE
  Whole-pelvis (WP) concurrent chemoradiation (CCRT) is the standard bladder preserving option for patients with invasive bladder cancer. The standard practice is to treat elective pelvic lymph nodes, so our aim was to evaluate whether bladder-only (BO) CCRT leads to results similar to those obtained by standard WP-CCRT.
  
  
  METHODS
  Patient eligibility included histopathologically proven muscle-invasive bladder cancer, lymph nodes negative (T2-T4, N-) by radiology, and maximal transurethral resection of bladder tumor with normal hematologic, renal, and liver functions. Between March 2005 and May 2006, 230 patients were accrued. Patients were randomly assigned to WP-CCRT (120 patients) and BO-CCRT (110 patients). Data regarding the toxicity profile, compliance, initial complete response rates at 3 months, and occurrence of locoregional or distant failure were recorded.
  
  
  RESULTS
  With a median follow-up time of 5 years (range, 3-6), WP-CCRT was associated with a 5-year disease-free survival of 47.1% compared with 46.9% in patients treated with BO-CCRT (p = 0.5). The bladder preservation rates were 58.9% and 57.1% in WP-CCRT and BO-CCRT, respectively (p = 0.8), and the 5-year overall survival rates were 52.9% for WP-CCRT and 51% for BO-CCRT (p = 0.8).
  
  
  CONCLUSIONS
  BO-CCRT showed similar rates of bladder preservation, disease-free survival, and overall survival rates as those of WP-CCRT. Smaller field sizes including bladder with 2-cm margins can be used as bladder preservation protocol for patients with muscle-invasive lymph node-negative bladder cancer to minimize the side effects of CCRT.
authors.affiliation: Department of Radiation Oncology, Sindh Institute of Urology & Transplantation, Karachi, Pakistan. drmutahirtonio@hotmail.com
authors.forename: Mutahir A
authors.initials: MA
authors.lastname: Tunio
authors.forename: Altaf
authors.initials: A
authors.lastname: Hashmi
authors.forename: Abdul
authors.initials: A
authors.lastname: Qayyum
authors.forename: Rehan
authors.initials: R
authors.lastname: Mohsin
authors.forename: Ahmed
authors.initials: A
authors.lastname: Zaeem
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010388:Pelvis; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D015996:Survival Rate; D001743:Urinary Bladder; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D011838:Radiation-Sensitizing Agents; D002945:Cisplatin