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Induction chemotherapy for unresectable urothelial carcinoma of the bladder
Author(s) -
Ghadjar Pirus,
Burkhard Fiona C.,
Gautschi Oliver,
Thalmann George N.,
Studer Urs E.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09574.x
Subject(s) - medicine , cystectomy , gemcitabine , bladder cancer , carboplatin , chemotherapy , urology , oncology , cisplatin , 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. 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.