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

Aim of the study: To 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 methods: Between 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.

Results: In 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.

Conclusions: Conservative 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.