Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer
| Autor: | Manuel Cobo, Raquel Delgado, Silvia Gil, Ismael Herruzo, Víctor Baena, Francisco Carabante, Pilar Moreno, José Luis Ruiz, Juan José Bretón, M. José, null del Rosal, Carlos Fuentes, Paloma Moreno, Emilio García, Esther Villar, Jorge Contreras, Inmaculada Alés, Manuel Benavides |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty medicine.medical_treatment Urology Antineoplastic Agents Kaplan-Meier Estimate Vinblastine Deoxycytidine Cystectomy Antineoplastic Combined Chemotherapy Protocols medicine Carcinoma Humans Aged Neoplasm Staging Carcinoma Transitional Cell Bladder cancer Radiotherapy medicine.diagnostic_test business.industry Induction chemotherapy General Medicine Cystoscopy Middle Aged medicine.disease Combined Modality Therapy Gemcitabine Neoadjuvant Therapy Methotrexate Transitional cell carcinoma Urinary Bladder Neoplasms Oncology Concomitant Urologic Surgical Procedures Female Cisplatin business Febrile neutropenia |
| Zdroj: | Clinical and Translational Oncology. 8:903-911 |
| ISSN: | 1699-3055 1699-048X |
| DOI: | 10.1007/s12094-006-0154-1 |
| Popis: | Organ preservation has been investigated in patients (p) with infiltrating transitional cell carcinoma (TCC) of the bladder over the past decade as an alternative to radical cystectomy. This is a trimodal schedule study, including transurethral resection of bladder tumor (TURB), neoadjuvant chemotherapy and concomitant radiochemotherapy (RTC). From April 1996 until August 2005, 29 evaluable patients (p) with T2-T3NXM0 bladder cancer were enrolled. After a transurethral resection of bladder tumor (TURB), we administered 2 cycles of induction chemotherapy with CMV (15 p) or Gemcitabine-Cisplatin (14 p) followed by radiotherapy 45 Gy 1.8 Gy/fraction and two cycles of concomitant cisplatin 70 mg/m2. 2–3 weeks later, a cystoscopy with tumor-site biopsy was performed. If complete histological response, p were treated with consolidation radiotherapy until 64.8 Gy. For p with residual or recurrent tumor, cystectomy was performed. We included 28 men and 1 women (median age 63, range 39–72 years) with PS (ECOG) 0–1. The stage was: 21 p T2; 6 p T3a; and 2 p T3b. Toxicity was higher in CMV compared with Gem-Cis: grade 3/4 neutropenia 4/15 (26%) vs 1/14 (7%); febrile neutropenia 3/15 (20%) vs 1/14 (7%); grade 3/4 trombocytopenia 2/15 (13%) vs 1/14 (7%). Toxicities with concomitant RCT were low-moderate: urocystitis (26%) and enteritis (18%). Response: microscopically complete TURB was obtained in 20 p (69%), but not in 9 p (31%) (7 microscopic, and 2 macroscopic residual tumor). We found a complete histologic response after induction RCT in 25 p (86%). After a median follow-up of 69.4 months (m) (range: 8–97.7), there were 8 deaths, with a overall survival of 72%. Furthermore 14 of 29 p (48%) were alive with intact bladder, and median survival time with intact bladder was 63.6 m (50.1–77.2); were predictive of best outcome T2 stage vs T3 (p |
| Databáze: | OpenAIRE |
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