title: Prognostic value of complete response in patients with muscle-invasive bladder cancer undergoing concurrent chemoradiotherapy.
abstract: OBJECTIVE
  To evaluate the feasibility of concurrent chemoradiotherapy (CCRT) in very advanced bladder cancer (stage IV) and further analyze the prognostic factors in these patients.
  
  
  METHODS
  We retrospectively reviewed the clinicopathological features and outcomes of patients with muscle-invasive bladder cancer after CCRT. Sixty-one patients with muscle-invasive bladder cancer who underwent CCRT between January 1996 and March 2011 were eligible for evaluation. Chemotherapy consisted of cisplatin (50 mg/m(2)) at day one, and 5-fluorouracil (500 mg/m(2)/day) and leucovorin (50 mg/m(2)/day) at days 1, 2, and 3, every three weeks, for a maximum of six cycles. The radiation dose was 44-45 Gy to the entire pelvis and 60-66 Gy to the entire bladder, with a daily fraction of 1.8-2 Gy.
  
  
  RESULTS
  By August 2012, the estimated median progression-free survival (PFS), cancer-specific survival, and overall survival (OS) were 25.7, 64.3 and 35.8 months, respectively; the complete response (CR) rate was 68.8%. Both clinical stage and CR following CCRT, were independent prognostic factors for PFS, cancer-specific survival, and OS. Patients with stage IV disease who achieved CR had significantly better PFS (log-rank p=0.01), cancer-specific survival (log-rank p=0.01), and OS (log-rank p=0.01) than those with stage II/III disease but no CR. The absence of hydronephrosis was the only factor predictive of CR after CCRT (odd ratio, 4.21; p=0.04).
  
  
  CONCLUSIONS
  CR was the most important prognostic factor in muscle-invasive bladder cancer. Selected patients with stage IV bladder cancer could benefit from CCRT if a CR is achieved.
authors.affiliation: Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
authors.forename: Chiao-En
authors.initials: CE
authors.lastname: Wu
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Lin
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Hong
authors.forename: Cheng-Keng
authors.initials: CK
authors.lastname: Chuang
authors.forename: See-Tong
authors.initials: ST
authors.lastname: Pang
authors.forename: Chuang-Chi
authors.initials: CC
authors.lastname: Liaw
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D006869:Hydronephrosis; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000628:therapy*
chemical_list: D014408:Biomarkers, Tumor; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil
keywords: Bladder cancer; complete response; concurrent chemoradiotherapy; hydronephrosis