Treatment of muscle invasive bladder cancer. Is there a role for neoadjuvant chemotherapy?

A. Kuten, M. Baz, R. Rubinov, J. Dale, N. Haim, E. Robinson, Y. Cohen

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Purpose: Because 5-year survival with advanced bladder cancer is still poor, the search for optimal treatment continues as does the necessity of clarifying goals of treatment. Patients and methods: We compared the outcome of 3 different but widely accepted treatment protocols for bladder cancer in order to find which, if any, was superior, with particular emphasis upon the performance of the newest treatment, neoadjuvant chemotherapy. Data on 224 bladder patients treated at our institution (1975 to 1991) with 1 of the 3 protocols was analyzed. Those protocols were: 1. radiotherapy > 60 Gy (143 patients); 2. low dose radiotherapy followed by cystectomy (25 patients); 3. chemotherapy followed by either definitive radiotherapy or surgery (56 patients). Because the latter group was also a chronologically newer group with a shorter possible follow-up, we compared all treatments on the basis of 2-year survival, using Kaplan-Meier life tables. We briefly reviewed those modalities which are bladder-sparing because of the significance to quality of life of this factor. Results: Two-year survival figures for the patients were: 63% for those who received only radiotherapy; 72% for those undergoing cystectomy: 68% for the group to whom neoadjuvant chemotherapy was administered. The differences were not statistically significant. However, 23% of those patients treated neoadjuvantly were alive with intact bladders at 2 years. Conclusion: These results do not suggest that a superior survival advantage is associated with any of these 3 protocols and neoadjuvant chemotherapy, in particular, cannot be seen as conferring a new and important survival advantage. However, neoadjuvant chemotherapy followed by radiotherapy does permit bladder conservation and, given that life span will often be reduced, the importance of helping to keep the remainder of the patient's life as comfortable as possible, can hardly be overestimated.

Original languageEnglish
Pages (from-to)524-530
Number of pages7
JournalStrahlentherapie und Onkologie
Volume170
Issue number9
StatePublished - 29 Sep 1994
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

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