Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder.

Abstract

BACKGROUND:

Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy.

METHODS:

Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (± biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model.

RESULTS:

Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P < 0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4-127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature.

CONCLUSIONS:

Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.

• Authors: S Hafeez, A Horwich, O Omar, K Mohammed, A Thompson, P Kumar, V Khoo, N Van As, R Eeles, D Dearnaley, R Huddart
• Journal: British journal of cancer (Br J Cancer) Vol. 112 Issue 10 Pg. 1626-35 (May 12 2015) ISSN: 1532-1827 [Electronic] England
• PMID: 25897675 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cisplatin

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Carcinoma, Transitional Cell (drug therapy, pathology, radiotherapy, surgery)
• Chemotherapy, Adjuvant
• Cisplatin (administration & dosage)
• Cystectomy (methods)
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (drug therapy, pathology, radiotherapy, surgery)
• Organ Preservation (methods)
• Retrospective Studies
• Salvage Therapy (methods)
• Treatment Outcome
• Urinary Bladder (drug effects, pathology, radiation effects, surgery)