Induction Cisplatin and Fluorouracil-Based Chemotherapy Followed by Concurrent Chemoradiation for Muscle-Invasive Bladder Cancer
Journal
International Journal of Radiation Oncology Biology Physics
Journal Volume
75
Journal Issue
2
Pages
442-448
Date Issued
2009
Abstract
Purpose: To evaluate a multimodality bladder-preserving therapy in patients with muscle-invasive bladder cancer. Methods and Materials: Patients with stages T2-4aN0M0 bladder cancer suitable for cystectomy underwent radical transurethral resection and induction chemotherapy, followed by concurrent chemoradiotherapy (CCRT). Patients with a Karnofsky performance status (KPS) <80 or age ?70 years underwent Protocol A: induction chemotherapy with three cycles of the cisplatin and 5-fluorouracil (CF) regimen, and CCRT with six doses of weekly cisplatin and 64.8 Gy radiotherapy given with the shrinking-field technique. Patients with KPS ?80 and age <70 years underwent Protocol B: induction chemotherapy with three cycles of weekly paclitaxel plus the CF regimen, and CCRT with six doses of weekly paclitaxel and cisplatin plus 64.8 Gy radiotherapy. Interval cystoscopy was employed after induction chemotherapy and when radiotherapy reached 43.2 Gy. Patients without a complete response (CR) were referred for salvage cystectomy. Results: Among 30 patients (median, 66 years) enrolled, 17 and 13 patients underwent Protocol A and B, respectively. After induction chemotherapy, 23 patients achieved CR. Five (17%) of 7 patients without CR underwent salvage cystectomy. Overall, 28 patients (93%) completed the protocol treatment. Of 22 patients who completed CCRT, 1 had recurrence with carcinoma in situ and 3 had distant metastases. After a median follow-up of 47 months, overall and progression-free survival rate for all patients were 77% and 54% at 3 years, respectively. Of 19 surviving patients, 15 (79%) retained functioning bladders. Conclusions: Our protocols may be alternatives to cystectomy for selected patients who wish to preserve the bladder. ? 2009 Elsevier Inc. All rights reserved.
SDGs
Other Subjects
Antineoplastic agents; Bladder neoplasms; Fluorouracil; Paclitaxel; Transitional cell carcinoma; Cell membranes; Fish; Muscle; Platinum compounds; Radiotherapy; Tumors; Chemotherapy; betamethasone; cisplatin; diphenhydramine; fluorouracil; folinic acid; paclitaxel; ranitidine; adult; aged; anemia; article; bladder cancer; brain toxicity; cancer recurrence; cancer survival; carcinoma in situ; clinical article; controlled study; cystoscopy; diarrhea; distant metastasis; female; fever; follow up; gastrointestinal toxicity; groups by age; hematuria; human; infection; Karnofsky Performance Status; leukopenia; liver toxicity; male; nausea; nephrotoxicity; neutropenia; priority journal; radiation dose; stomatitis; thrombocytopenia; treatment response; vomiting; Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Clinical Protocols; Combined Modality Therapy; Cystectomy; Drug Administration Schedule; Female; Fluorouracil; Follow-Up Studies; Humans; Karnofsky Performance Status; Male; Paclitaxel; Radiotherapy Dosage; Remission Induction; Salvage Therapy; Survival Rate; Urinary Bladder Neoplasms
Type
journal article