Bladder preservation by neoadjuvant chemotherapy followed by gemcitabine as radiosensitizer for muscle-invasive transitional cell carcinoma of the urinary bladder after maximal TURBT

摘要

Objectives: To evaluate prospective phase II study of neoadjuvant chemotherapy and gemcitabine as radiosensetizer in conservative management of muscle-invasive transitional cell carcinoma of the urinary bladder . Patients and methods: Forty eight patients with transitional cell carcinoma, stage T2b-T4aN0M0, bladder cancer underwent maximal TURBT followed by neoadjuvant chemotherapy carboplatin AUC5 D1 and gemcitabine 1000 mg/m² D1and D8 repeated every 21 days for 2 cycles followed by concurrent radiation 65Gy with Gemcitabine given intravenously at 100 mg/m² on days 1, 8, 15, 22, 29, 36. The end points were tumor response, toxicity and survival. Results: The neoadjuvant as well as concurrent chemoradiotherapy were tolerated with low toxicity rates as the following, Urinary Bladder irritative symptoms developed in 2 patients (4.1%) and successfully managed with antimuscarinic. Neutropenia occurred in 4 patients (8.3%) while febrile neutropenis in 1 patient (2%). Nausea and vomiting occurred in 6 patients (12.5%) while nephrotoxicity occurred in 2 patients (4.1%). Complete response was noted in 28 patients (58.3%). Partial response was observed in 15 patients (31.25%). At time of analysis, there were fourteen deaths (29.1%) due to bladder cancer. Three-year cancer specific survival (CSS) and overall survival (OS) were 69.9% and 66.6%. Twenty one patients (43.7%) were tumor free and kept their bladder at time of analysis . Conclusion: Neoadjuvant chemotherapy followed by gemcitabine as radiosensitizer for muscle-invasive transitional cell carcinoma of the urinary bladder was tolerable with good bladder preservation and overall survival .