Transurethral resection, neoadjuvant chemotherapy and accelerated hyperfractionated radiotherapy – concomitant boost, with or without concurrent cisplatin, for patients with invasive bladder cancer – clinical outcome

Abstract

Aim of the studyTo evaluate the toxicity, clinical effectiveness and survival rate of transurethral resection, neoadjuvant chemotherapy and accelerated hyperfractionated radiotherapy (concomitant boost), with or without concurrent cisplatin in patients with muscle invasive bladder cancer.Material and methodsBetween March 2004 and December 2009, 35 patients with histologically proven invasive carcinoma of the bladder (T2-4a, N0-1, M0), who were fit for combined radiochemotherapy and refused radical surgery or were medically or surgically inoperable, were selected for the bladder-sparing protocol.ResultsIn this study, twenty-five patients (25/35; 72%) received two cycles of neoadjuvant chemotherapy, and ten of them (10/35; 28%) only one, because of treatment-related toxicity. In twenty-one patients (21/35; 60%) chemotherapy consisting of gemcitabine with cisplatin and in fourteen patients (14/35; 40%) gemcitabine with carboplatin were applied. Only 13 patients (13/35; 37%) received combined irradiation with cisplatin. All patients completed their planned course of radiation therapy. Complete response (CR) occurred in 26/35 (74%) patients, partial response (PR) in 2/35(6%), and stable disease (SD) in 7/35 (20%). The overall actuarial survival rates at 3 and 5 years were 75% and 66%, respectively. Disease-specific actuarial survival rates at 3 and 5 years were 81% and 71%, respectively.ConclusionsConservative treatment of patients with muscle-invasive bladder cancer by transurethral resection, neoadjuvant chemotherapy, and accelerated hyperfractionated radiotherapy with concomitant boost, with or without concurrent cisplatin, provides a high probability of local and distal response with acceptable toxicity in properly selected patients.

Bladder preservation by neoadjuvant chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer

“…The research used maximal TURBT, 2 cycles of NACT with Gemzar/Cisplatin, followed by RT with or without radiosensitizer, and revealed an overall response rate of 78%, CR at 30%, PR at 48%, and SD at 22%. Our study yielded comparable results, with an overall NACT response rate of 79.4% [31].…”

“…According to Giacalone et al ., who reported long-term results of patients with BC treated with tri-modality therapy, CR increased from 66 to 88% between 1986 and 2013 [ 30 ]. The research used maximal TURBT, 2 cycles of NACT with Gemzar/Cisplatin, followed by RT with or without radiosensitizer, and revealed an overall response rate of 78%, CR at 30%, PR at 48%, and SD at 22%.…”