Concurrent chemoradiotherapy for clinical stage T2 bladder cancer: report of a single institution

• Published in: Urology (Ridgewood, N.J.) N.J.), 2004, Vol.63 (1), p.73-77
• Main Authors: Peyromaure, Michaël, Slama, JerÔme, Beuzeboc, Philippe, Ponvert, Dominique, Debré, Bernard, Zerbib, Marc
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; BCG Vaccine - therapeutic use; Biological and medical sciences; Carboplatin - administration & dosage; Carcinoma, Transitional Cell - drug therapy; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - radiotherapy; Carcinoma, Transitional Cell - surgery; Carcinoma, Transitional Cell - therapy; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Combined Modality Therapy; Cystectomy - methods; Disease-Free Survival; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Humans; Life Tables; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Nephrology. Urinary tract diseases; Radiotherapy, Adjuvant; Survival Analysis; Treatment Outcome; Tumors of the urinary system; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - radiotherapy; Urinary Bladder Neoplasms - surgery; Urinary Bladder Neoplasms - therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2003.09.018

To report our experience with concurrent chemoradiotherapy for clinical Stage T2 bladder cancer. From 1996 to 2002, 43 patients were treated with concurrent chemotherapy and radiotherapy for clinical Stage T2 bladder cancer. After complete bladder transurethral resection, all patients underwent chemotherapy, consisting of one daily infusion of cisplatin at a dose of 15 mg/m 2 and 5-fluorouracil at a dose of 400 mg/m 2 on days 1 to 3 (first cycle) and days 15 to 17 (second cycle). Pelvic irradiation was administered at a dose of 24 Gy, using two daily fractions of 3 Gy on days 1, 3, 15, and 17. Random biopsies were performed 6 weeks after the end of the first two cycles. Patients with persistent invasive tumor underwent cystectomy; others received two additional cycles of concurrent chemoradiotherapy. The mean follow-up was 36.3 months (range 3 to 72). Nine patients underwent early cystectomy for nonresponse, and 2 patients underwent delayed cystectomy. The overall rate of cystectomy was 25.6%. The rate of specific survival at 3 and 5 years was 75% and 60%, respectively. The overall rate of recurrence-free survival at 3 and 5 years was 63% and 33%, respectively. Two factors correlated with patient survival: the presence of carcinoma in situ at first resection ( P = 0.01) and the response after the first two cycles (half dose; P = 0.004). In our experience, concurrent chemoradiotherapy is less effective than primary cystectomy for clinical Stage T2 bladder cancer. This treatment may be unwarranted in patients with concomitant carcinoma in situ at the first resection.