Treatment trends and outcomes of small-cell carcinoma of the bladder.
OBJECTIVE
Treatment for small-cell carcinoma of the bladder is largely guided by case reports, retrospective reviews, and small prospective trials. This study aimed to study outcomes using a large population-based database.


METHODS
The Surveillance, Epidemiology, and End Results-Medicare database (1991-2005) was used to analyze how different treatment combinations of specific bladder surgeries, chemotherapy, and radiation affected patient outcomes. Trends in the use of these combinations over time were also analyzed.


RESULTS
A total of 533 patients were retrieved from the database. A bladder-sparing approach involving transurethral resection of the bladder tumor (TURBT) combined with chemotherapy and radiation yielded no significant difference in overall survival compared with patients undergoing at least a cystectomy (of whom over 90% received radical cystectomy) with chemotherapy (p > 0.05). The analysis of treatment trends indicated that these two general strategies for cure combined to account for fewer than 20% of patients. A majority of patients (54%) received TURBT as their only surgical treatment, and a subset analysis of these patients indicated that chemotherapy played a role in all stages of disease (p < 0.05) whereas radiation improved overall survival in regional-stage disease (p < 0.05).


CONCLUSIONS
Relatively few patients with small-cell carcinoma of the bladder receive potentially curative therapies. Chemotherapy should be a major component of treatment. Cystectomy and bladder-sparing approaches represent two viable strategies and deserve further investigation to identify the patients who may benefit from organ preservation or not. In addition, the role of radiation in regional-stage disease should be investigated further, because it positively affects survival after TURBT.
Baylor College of Medicine, Houston, Texas, USA.
Eugene J
EJ
Koay
Bin S
BS
Teh
Arnold C
AC
Paulino
E Brian
EB
Butler
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy / Q000639:trends; D015653:Cystectomy / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology; D059351:Organ Sparing Treatments / Q000639:trends; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000628:therapy*
D000970:Antineoplastic Agents