Conservative treatment in patients with muscle-invasive bladder cancer by transurethral resection, neoadjuvant chemotherapy with gemcitabine and cisplatin, and accelerated radiotherapy with concomitant boost plus concurrent cisplatin – assessment of response and toxicity.

Abstract

Background

Curative treatment options for invasive bladder cancer include radical cystectomy and therapeutic strategies with bladder preservation.

Aim

To evaluate the toxicity and clinical effectiveness of transurethral resection, neoadjuvant chemotherapy with gemcitabine and cisplatin, and accelerated radiotherapy with concomitant boost plus concurrent cisplatin in muscle invasive bladder cancer.

Materials and Methods

Between October 2005 and March 2008, 27 patients with histologically proven invasive carcinoma of the bladder (T2-4a,N0-1,M0) who were fit for combined radiochemotherapy and refused radical surgery were selected to bladder-sparing protocol.

Results

In this study, a group of twenty one patients (78%) received two cycles of chemotherapy, and six of them (22%) only one, because of treatment related toxicity. Complete response after finished conservative treatment: transurethral resection, neoadjuvant chemotherapy with gemcytabin and cisplatin, and accelerated hyperfractionated radiotherapy with concomitant boost plus concurrent cisplatin, occurred in 18 patients (67%), partial response in 2 (8%), stable disease in 7(25%). Toxicities for hematologic and nonhematologic parameters during neoadjuvant chemotherapy were acceptable.

Conclusion

Conservative treatment in patients with muscle-invasive bladder cancer provides a high probability of local response with acceptable toxicity in properly selected patients.