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Concomitant Administration of Cisplatin and Irradiation Offers Effective Treatment in Patients With Bladder Cancer

Preoperative treatment with cisplatin plus concomitant 40-Gy radiation effectively suppresses cancer cells in patients with localised muscle-invasive bladder cancer, according to a new study.

While radical cystectomy is standard treatment for muscle invasive bladder cancer, local recurrence or distant metastasis develops in approximately half of cases. To improve prognosis, several adjuvant chemotherapy or radiotherapy protocols have been assessed, but did not yield satisfactory results.

Recently, promising results with concurrent radiochemotherapy using cisplatin have been reported. To investigate the feasibility of this protocol, Yukio Kageyama, MD, PhD, and colleagues of the Tokyo Medical and Dental University, Japan performed a study in which 50 patients with bladder cancer were treated preoperatively with concurrent cisplatin and irradiation.

The patient population had a median age of 70 years and diagnosis of localised muscle-invasive bladder cancer (stages T2, T3, and T4).

Patients received pelvic irradiation at a dose of 40 Gy in 4 to 5 weeks. During weeks 1 and 4 of radiation therapy, patients received systemic (20 mg/body for 5 days) or intra-arterial (100 mg/body) administration of cisplatin.

Adverse events were mild and consisted of nausea/vomiting, diarrhoea, and myelosuppression.

Clinical complete regression was achieved in 20 patients and partial regression in 30 patients. Radical cystectomy was performed for all patients with partial regression and 9 patients with complete regression, and an additional 11 patients with complete regression underwent partial cystectomy due to advanced age, poor condition, or a reluctance to have radical surgery.

Eighteen patients were determined freeof residual tumour (T0 response). Patients receiving partial cystectomy showed negative transurethral biopsy after chemoradiotherapy. Among patients with complete regression, 2 patients of the partial cystectomy group were observed to have a small number of residual tumour cells present in surgical specimens.

The estimated 3-year overall survival was 82%. The estimated disease-free survival for all patients was 75% and 100% for T0 responders.

In 8 patients with pathologic persistent tumour, local recurrence (2 patients) or distant metastasis (6 patients) developed. Interestingly, all patients who underwent partial cystectomy were recurrence free for observation periods up to 59 months.

"Because preservation of bladder by transurethral resection is hampered by the risk of understaging and requires additional irradiation for consolidation after induction chemoradiotherapy, partial cystectomy may be a choice against solitary muscle-invasive bladder cancer in elderly or high-risk patients who showed complete regression to the preoperative chemoradiotherapy," suggest the researchers.

Am J Clin Oncol 2003 Oct;26:5:504-7. "Favorable outcome of preoperative low dose chemoradiotherapy against muscle-invasive bladder cancer"

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