Combined chemotherapy and radiation with selective organ preservation for muscle-invasive bladder carcinoma. A single-institution phase II study
| Autor: | G. Fellin, Orazio Caffo, G. Ambrosini, Lucio Luciani, A. Bolner, U. Graffer |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology medicine.medical_treatment Vinblastine Cystectomy Antineoplastic Combined Chemotherapy Protocols medicine Combined Modality Therapy Humans Neoplasm Invasiveness Prospective Studies Radical surgery Survival rate Aged Carcinoma Transitional Cell Urinary bladder medicine.diagnostic_test business.industry Combination chemotherapy Cystoscopy Middle Aged Survival Analysis Surgery Radiation therapy Survival Rate medicine.anatomical_structure Methotrexate Treatment Outcome Urinary Bladder Neoplasms Female Cisplatin business |
| Zdroj: | British journal of urology. 80(1) |
| ISSN: | 0007-1331 |
| Popis: | Objective To assess in a phase II trial the effectiveness and toxicity of combined chemotherapy and radiation with selective bladder preservation by response in the treatment of muscle-invasive bladder carcinoma. Patients and methods Fifty-six eligible patients with T2-4 MO transitional cell bladder cancer suitable for radical surgery and multi-agent chemotherapy received two courses of methotrexate, cisplatin and vinblastine, followed by 40 Gy of pelvic radiotherapy in 1.8Gy fractions with concomitant cisplatin. Tumour response was evaluated by cystoscopy and biopsy. Those responding completely were given a 24Gy bladder boost plus cisplatin; patients with residual tumour were assigned to immediate cystectomy. Results After induction therapy, 28 patients (50%) responded completely; 22 operable patients with residual tumour underwent immediate cystectomy, while 34 patients were consolidated with cisplatin and radiation. Bladder relapses developed in 16 patients; seven had successful endovesical therapy for superficial disease and salvage cystectomy was possible in four of nine cases with invasive recurrence. Distant metastases occurred in 22 cases (39%). After a median follow-up of 46 months, the 5-year actuarial disease-specific survival was 59%, disease-free survival 54% and local control without cystectomy (bladder preservation) 41%. There were no treatment-related deaths; grade 3 late complications occurred in two patients. Conclusion This combined chemotherapy-radiotherapy regimen with selective organ preservation should be considered as an option for muscle-invasive bladder carcinoma. The initial results suggest the possibility of retaining a functioning bladder in many patients, without compromising survival, compared with elective cystectomy approaches. A longer follow-up and quality-of-life assessment remain essential for a better definition of selection criteria and long-term results of this combined modality. |
| Databáze: | OpenAIRE |
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