title: The natural history of clinically complete responders to neoadjuvant chemotherapy for urothelial carcinoma of the bladder.
abstract: OBJECTIVE
  We describe the clinical course of patients who achieved cT0 status after neoadjuvant chemotherapy for muscle invasive bladder cancer. There is no established treatment paradigm for these patients.
  
  
  METHODS
  We retrospectively reviewed the records of 109 patients with muscle invasive bladder cancer (T2 or greater urothelial carcinoma of the bladder) who underwent platinum based neoadjuvant chemotherapy at our institution from 1988 to 2012. Post-chemotherapy assessment of the response included cytology, cystoscopy with biopsy and cross-sectional imaging.
  
  
  RESULTS
  Of 109 patients 32 (29.4%) achieved cT0 status after neoadjuvant chemotherapy. Mean ± SD age of the cohort was 68.3 ± 9.6 years. Of the patients 21 received MVAC, 8 received gemcitabine and cisplatin, and 3 received another regimen. Seven complete responders elected immediate radical cystectomy after the completion of neoadjuvant chemotherapy. Of 25 patients who refused radical cystectomy after achieving cT0 status 7 experienced relapse after the completion of neoadjuvant chemotherapy and proceeded to radical cystectomy. The remaining 18 patients (72%) retained the bladder, including 6 (18.8% of the cohort) in whom nonmuscle invasive relapses were managed conservatively and 12 (37.5%) with no recurrence. In the 25 patients who elected bladder preservation after achieving cT0 status following neoadjuvant chemotherapy 5-year cancer specific survival was 88%.
  
  
  CONCLUSIONS
  With proper counseling and identification of treatment goals patients with cT0 after neoadjuvant chemotherapy for muscle invasive bladder cancer may have the option to retain the bladder with durable survival. Larger studies are needed to identify possible predictors of response on the clinical, pathological and molecular levels.
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York. Electronic address: arm2136@columbia.edu.
authors.forename: Alexa
authors.initials: A
authors.lastname: Meyer
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Rashed
authors.initials: R
authors.lastname: Ghandour
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Ari
authors.initials: A
authors.lastname: Bergman
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Crystal
authors.initials: C
authors.lastname: Castaneda
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wosnitzer
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Greg
authors.initials: G
authors.lastname: Hruby
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Benson
authors.affiliation: Department of Urology, Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York.
authors.forename: James
authors.initials: J
authors.lastname: McKiernan
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D012074:Remission Induction; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*
keywords: carcinoma; cystectomy; drug therapy; neoplasm invasiveness; urinary bladder