Evidence Supporting Preoperative Chemotherapy for Small Cell Carcinoma of the Bladder: A Retrospective Review of the M. D. Anderson Cancer Experience

Abstract

Like other neuroendocrine tumors, small cell carcinoma of the bladder grows rapidly but is chemo-sensitive. Clinical under staging is the rule. Optimal results are achieved via integration of local and systemic treatment. Our results suggest that preoperative chemotherapy is the optimal strategy, even in the setting of clinically localized cancer. On the basis of these observations, we have initiated a trial in which 4 cycles of aggressive multiagent preoperative chemotherapy are followed by radical cystectomy.

Primary Small Cell Carcinoma of the Urinary Bladder - Mini-review of the Literature

“…Therefore, mixed SCCB mandates the classic cisplatin based chemotherapy (Grignon et al, 1992;Holmäng et al, 1995;Angulo et al, 1996;Mackey et al, 1998). There is also documentation in previous literature concluding successful eradication in pure and mixed SCCBs following preoperative chemotherapy with a neuroendocrine regimen containing etoposide and cisplatin or ifosfamide and doxorubicin (Siefker-Radtke et al, 2004). However, methotrexate, vinblastine, doxorubicin and cisplatin regimen is favored if the transitional cell component obtained at trans urethral resection is greater than 50% as mentioned in earlier studies (Grignon et al, 1992).…”

“…Nonetheless, the gold standard for the treatment of SCCB remains platinum based chemotherapy with a major preference to cisplatin-etoposide regimen used both in limited or extensive stage (Sidhu, 1979;Blomjous et al, 1989;Oesterling et al, 1990;Cheng et al, 1992;Lopez et al, 1994;Syed et al, 1997;Mackey et al, 1998;Lohrisch et al, 1999;Trias et al, 2001;Helpap, 2002;Siefker-Radtke et al, 2004, Choong et al, 2005; Other chemotherapy regimens available is etoposide-cisplatine alternating protocol either with ifosfamide-doxorubicin or with cyclophosphamide, doxorubicin and vincristine. The use of single agents such as paclitaxel, irinotecan, topotecan, and doxorubicin, has also been documented (Siefker-Radtke et al, 2004;Choong et al, 2005). Previous studies have mentioned the benefit of cisplatinbased chemotherapy in the treatment of SCCB (Mills et al, 1987;Blomjous et al, 1989;Christopher et al, 1991;Grignon et al, 1992); Mackey et al (1998) stated that regimens not including cisplatin were not associated with prolonged survival.…”

“…The use of single agents such as paclitaxel, irinotecan, topotecan, and doxorubicin, has also been documented (Siefker-Radtke et al, 2004;Choong et al, 2005). Previous studies have mentioned the benefit of cisplatinbased chemotherapy in the treatment of SCCB (Mills et al, 1987;Blomjous et al, 1989;Christopher et al, 1991;Grignon et al, 1992).…”

Management of small cell carcinoma of the bladder: Consensus guidelines from the Canadian Association of Genitourinary Medical Oncologists (CAGMO)

“…20,28,38 Patients with a small cell component to their bladder tumour have a worse clinical outcome than patients with conventional UCB. 15,29,24,39 In addition, patients with a pure SCCB have a median overall survival for nonmetastatic, metastatic or recurrent disease (4.5-9.5 months) that is 2 to 3 times shorter compared to mixed SCCB. 21,26 Immunohistochemical staining is important to support a diagnosis of SCCB, which typically exhibits both epithelial and neuroendocrine differentiation.…”

“…14,22,23,25 However, the natural history of SCCB is more aggressive and is associated with poorer prognosis than UCB. Therefore, in most cases, SCCB will be locally advanced or metastatic [20][21][22][23][26][27][28][29] at diagnosis and follow a pattern of metastases similar to UCB. The most common sites of spread are regional and distant lymph nodes, liver and bones.…”