Re: Novel Bladder Preservation Therapy with Osaka Medical College Regimen

Abstract

can provide future direction toward bladder preservation in patients with bladder cancer. As they seem to have achieved good results, some points need to be explained.No mention was made about the morbidity related to the procedure itself. Number of cycles of the regimen (single or multiple) and timing of radiotherapy (simultaneous or metachronous, before or after chemotherapy) also were not specified. Timing of balloon deflation after the procedure and removal of the catheter should also be clear, as premature balloon deflation could release a massive dose of cisplatin to the systemic circulation. Use of any pre-medications, precautions or anticoagulation was not specified. As this is a novel technique, these points deserve mention.It is also unclear whether gemcitabine was used. The graphic in the article states that gemcitabine was given but this was not mentioned anywhere in the text. If gemcitabine was administered, then we also seek clarification about the dosing and side effect profile.One of the important aspects of systemic treatment with chemotherapeutic agents is treatment of micrometastases. This regimen aims to reduce systemic dosage. Does this decreased systemic dose have any adverse impact on the effective treatment of micrometastases? In other words, are the systemic levels achieved in this regimen sufficient to treat micrometastases?The modality used for initial staging was not mentioned (imaging with or without transurethral resection). Transurethral resection in patients with T2 disease, consisting of complete resection of the primary tumor, can potentially affect the outcome (complete response, progression-free survival, overall survival). Furthermore, the effect of histological grade (high or low) of urothelial tumor on outcomes was not mentioned, which is an important prognostic factor.The presence of hydronephrosis was a significant risk factor. It is unclear whether the degree of hydronephrosis or its association with obstructive uropathy has any impact and whether urinary diversion reverses the risk.In patients with Nþ disease was the response assessment done only for primary tumor or for primary tumor and lymph nodes (LNs)? What was the nodal response? Patients with progression in this study were treated with either bacillus Calmette-Gu erin (BCG) therapy or cystectomy. Were outcomes of this group different from the general population undergoing BCG treatment or cystectomy? We request that the authors explain these issues.Respectfully,