Neoadjuvant chemotherapy for invasive bladder carcinoma

Disease outcome and bladder preservation and relationship to local tumor response

Paul Hatcher, R. G. Hahn, R. L. Richardson, H. Zincke

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Thirty-nine patients with locally advanced transitional cell carcinoma of the bladder received presurgical combination chemotherapy in an effort to improve survival, reduce local tumor recurrence and distant failure, and enhance surgical resectability and potentially salvage the bladder. One to six cycles (median 2.8) of M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin), CMV (cisplatin, methotrexate, vinblastine), or VP16 CDDP (etoposide, cisplatin) were administered after initial diagnosis and clinical staging of the bladder cancer and transurethral resection of the tumor. Clinical staging was repeated before each cycle of chemotherapy. Transurethral resection and systemic neoadjuvant chemotherapy clinically downstaged 31 of 39 patients (79%). Subsequently, 26 patients underwent radical cystectomy and 13 patients received bladder salvage (6 received a partial surgical resection and 7 observation). At 41 months' median follow-up, 4-year overall survival was 63 ± 17%, cancer-specific survival was 71 ± 19%, local recurrence-free survival was 66 ± 22%, and metastasis-free survival was 73 ± 16%. Patients with a complete clinical and pathologic response had far better survival than those without a complete response; for pathologic stage, survival was 100% vs. 45% for those with residual tumor (p = 0.003). Local recurrence (T(a) or T(i)s) occurred in 46% of those with their bladder salvaged and still in situ. These data suggest that with neoadjuvant chemotherapy bladder salvage seems feasible in selected patients, although they appear to be at higher risk for tumor recurrence. Accurate selection of the group of patients most likely to benefit is difficult and may not be possible in a predictable manner with currently available selection methods.

Original languageEnglish (US)
Pages (from-to)209-215
Number of pages7
JournalEuropean Urology
Volume25
Issue number3
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

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Urinary Bladder Diseases
Urinary Bladder
Carcinoma
Drug Therapy
Survival
Neoplasms
Cisplatin
Recurrence
Vinblastine
Methotrexate
Transitional Cell Carcinoma
Cystectomy
Residual Neoplasm
Etoposide
Combination Drug Therapy
Urinary Bladder Neoplasms
Doxorubicin
Patient Selection
Observation
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Neoadjuvant chemotherapy for invasive bladder carcinoma : Disease outcome and bladder preservation and relationship to local tumor response. / Hatcher, Paul; Hahn, R. G.; Richardson, R. L.; Zincke, H.

In: European Urology, Vol. 25, No. 3, 01.01.1994, p. 209-215.

Research output: Contribution to journalArticle

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abstract = "Thirty-nine patients with locally advanced transitional cell carcinoma of the bladder received presurgical combination chemotherapy in an effort to improve survival, reduce local tumor recurrence and distant failure, and enhance surgical resectability and potentially salvage the bladder. One to six cycles (median 2.8) of M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin), CMV (cisplatin, methotrexate, vinblastine), or VP16 CDDP (etoposide, cisplatin) were administered after initial diagnosis and clinical staging of the bladder cancer and transurethral resection of the tumor. Clinical staging was repeated before each cycle of chemotherapy. Transurethral resection and systemic neoadjuvant chemotherapy clinically downstaged 31 of 39 patients (79{\%}). Subsequently, 26 patients underwent radical cystectomy and 13 patients received bladder salvage (6 received a partial surgical resection and 7 observation). At 41 months' median follow-up, 4-year overall survival was 63 ± 17{\%}, cancer-specific survival was 71 ± 19{\%}, local recurrence-free survival was 66 ± 22{\%}, and metastasis-free survival was 73 ± 16{\%}. Patients with a complete clinical and pathologic response had far better survival than those without a complete response; for pathologic stage, survival was 100{\%} vs. 45{\%} for those with residual tumor (p = 0.003). Local recurrence (T(a) or T(i)s) occurred in 46{\%} of those with their bladder salvaged and still in situ. These data suggest that with neoadjuvant chemotherapy bladder salvage seems feasible in selected patients, although they appear to be at higher risk for tumor recurrence. Accurate selection of the group of patients most likely to benefit is difficult and may not be possible in a predictable manner with currently available selection methods.",
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