title: Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder.
abstract: BACKGROUND
  Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy.
  
  
  METHODS
  Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (± biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model.
  
  
  RESULTS
  Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P < 0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4-127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature.
  
  
  CONCLUSIONS
  Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.
authors.affiliation: 1] The Royal Marsden NHS Foundation Trust, London, UK [2] The Institute of Cancer Research, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hafeez
authors.affiliation: 1] The Royal Marsden NHS Foundation Trust, London, UK [2] The Institute of Cancer Research, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Omar
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Mohammed
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Thompson
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Khoo
authors.affiliation: The Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Van As
authors.affiliation: 1] The Royal Marsden NHS Foundation Trust, London, UK [2] The Institute of Cancer Research, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Eeles
authors.affiliation: 1] The Royal Marsden NHS Foundation Trust, London, UK [2] The Institute of Cancer Research, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Dearnaley
authors.affiliation: 1] The Royal Marsden NHS Foundation Trust, London, UK [2] The Institute of Cancer Research, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Huddart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D015653:Cystectomy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D009926:Organ Preservation / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects / Q000601:surgery
chemical_list: D002945:Cisplatin