title: Bladder preservation by neoadjuvant chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer: experience at Sindh Institute of Urology & Transplantation (SIUT).
abstract: OBJECTIVE
  To identify any additional benefit and note the safety profile of neoadjuvant chemotherapy prior to concurrent chemoradiation in muscle-invasive bladder cancer.
  
  
  METHODS
  Forty three patients with T2b-T4N0M0 bladder cancer underwent maximal TURBT followed by neoadjuvant chemotherapy cisplatinum 75 mg/m[2] D1+ gemcitabine 1000 mg/m[2] D1, D8 & D15 repeated every 28 days for three cycles followed by concurrent radiation 65Gy and weekly cisplatinum 30 mg/m[2] or gemcitabine 100 mg/m[2]. Complete response (CR) was defined as no tumour seen on cystoscopy and biopsy. The disease control and overall survival were determined by Kaplan and Meier method and statistical inferences with the log-rank test. Cox regression analysis was used to find different prognostic factors.
  
  
  RESULTS
  Out of 43, thirty two patients (78.04%) achieved CR at time of cystoscopic evaluation. Six patients who did not achieve CR (14.63%) underwent salvage cystectomies, remaining were not operable. At the median follow up of 36 months, overall survival was 61%. Local recurrences were seen in 3 patients (10%) (2 pT1, 1pT2), distant metastases were seen in 2 patients (6.6%); 27/41 were alive, of whom 23 (56.1%) were retaining intact disease free bladders. The Tumour stage, incomplete TURBT and presence of hydronephrosis were important prognostic factors (log-rank p values 0.0001, 0.0001 and 0.001 respectively).
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy followed by concurrent chemoradiation was tolerable with better bladder preservation and overall survival.
authors.affiliation: Department of Radiation Oncology, Sindh Institute of Urology & Transplantation (SIUT), Karachi.
authors.forename: Mutahir Ali
authors.initials: MA
authors.lastname: Tunio
authors.forename: Altaf
authors.initials: A
authors.lastname: Hashmi
authors.forename: Mansoor
authors.initials: M
authors.lastname: Rafi
authors.forename: Abdul
authors.initials: A
authors.lastname: Qayyum
authors.forename: Rehan
authors.initials: R
authors.lastname: Masood
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D015653:Cystectomy; D003558:Cystoscopy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine