Induction chemotherapy for unresectable urothelial carcinoma of the bladder
Article first published online: 14 SEP 2010
© 2010 THE AUTHORS. JOURNAL COMPILATION © 2010 BJU INTERNATIONAL
Volume 107, Issue 6, pages 894–897, March 2011
How to Cite
Ghadjar, P., Burkhard, F. C., Gautschi, O., Thalmann, G. N. and Studer, U. E. (2011), Induction chemotherapy for unresectable urothelial carcinoma of the bladder. BJU International, 107: 894–897. doi: 10.1111/j.1464-410X.2010.09574.x
- Issue published online: 10 MAR 2011
- Article first published online: 14 SEP 2010
- Accepted for publication 22 April 2010
- bladder cancer;
Study Type – Therapy (case series) Level of Evidence 4
What’s known on the subject? and What does the study add?
In resectable muscle-invasive bladder cancer neoadjuvant chemotherapy followed by radical cystectomy confers to a significant 5% overall survival benefit. Less is known about induction chemotherapy followed by radical cystectomy in initially unresectable patients. Our retrospective analysis of a selected patient cohort suggests that patients with initially unresectable bladder cancer may benefit from this combined treatment approach.
• To analyse the outcome in selected patients with initially unresectable or minimally metastatic muscle-invasive urothelial bladder cancer who underwent induction chemotherapy (IC) followed by radical cystectomy (RC).
PATIENTS AND METHODS
• Thirty patients with initially unresectable, locally advanced or minimally metastatic bladder cancer underwent platinum-based IC followed by RC with curative intent at our institution from 2000 to 2007.
• They received a median of four cycles (range 2–6 cycles) of cisplatin and gemcitabine (n= 19), carboplatin and gemcitabine (n= 9) or other platinum combinations (n= 2).
• We retrospectively analysed all 30 patients for complete pathological remission (pT0), disease free survival (DFS) and overall survival (OS). Chi-square tests, Kaplan–Meier analyses, and Cox univariate modelling were used.
• Before IC, 30 patients were deemed unresectable because of locally advanced tumour classification (cT4, 18/30) and/or clinically suspected lymph node (LN) metastasis (21/30) or suspected distant metastasis (3/30).
• At re-staging after IC there was a complete regression of all enlarged LN in 16/21 patients, a partial LN response in one patient or stable LN size in the remaining four patients.
• After RC, 9/30 (30%) of patients had attained pT0.
• The median follow-up was 28 months (range 4–97 months). The 5-year DFS and OS rates were 42% and 46%, respectively, for all patients.
• In the pT0 patients, the DFS (83%) and OS (71%) rates were significantly higher than in non-pT0 patients.
• Patients undergoing IC followed by RC showed encouraging response and survival rates, suggesting that selected patients with initially unresectable bladder cancer benefit from this combined regimen.