SEARCH

SEARCH BY CITATION

Keywords:

  • chemotherapy;
  • bladder cancer;
  • survival

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.

OBJECTIVE

• 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.

RESULTS

• 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.

CONCLUSION

• 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.