title: Comparison of radical cystectomy and chemoradiotherapy in patients with locally advanced bladder cancer.
abstract: The aim of this study was to evaluate the clinical outcomes of radical cystectomy (RC) and concurrent chemoradiotherapy (CRT) with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with locally advanced bladder cancer (BC). From December 2000 to February 2012, 72 patients with locally advanced BC (T3-4a, N0 or N+, M0) received either RC or CRT. RC with bilateral pelvic lymph node dissection including the common iliac region as the standard procedure. Patients in the CRT group received one cycle of MVAC followed by radiotherapy with a half dose of MVAC and then two more cycles of MVAC. Standard fractionation at a daily dose of 1.8-2.0 Gy was used, with a median total dose of 50 Gy (range, 45-60 Gy). The 3-year progression-free survival (PFS) rates in the RC and CRT groups were 56.2% and 25.6%, respectively (p=-0.015) and the 3-year overall survival (OS) rates were 63.5% and 48.1% (p=0.272). Multivariate Cox proportional hazards regression analysis with application of a propensity score indicated that RC was a significant predictor of PFS (p=0.033) but not of OS (p=0.291). Among patients with locally advanced BC, PFS was significantly prolonged in the RC group compared with the CRT group. However, RC was not a significant predictor of OS. Although the sample size in this study was small, the results suggest that patient background and postoperative quality of life should be considered when choosing treatment strategy for locally advanced BC.
authors.affiliation: Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan E-mail : kazumasa@cd5.so-net.ne.jp.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Morihiro
authors.initials: M
authors.lastname: Nishi
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Tabata
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Fujita
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ishiyama
authors.forename: Kazushige
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Iwamura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D014747:Vinblastine; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate