Induction chemotherapy for unresectable urothelial carcinoma of the bladder

What's known on the subject? and What does the study add? In resectable muscle-invasive bladder cancer neoadjuvant chemotherapy followed by radical cystectomy confers to a significant 5% overall survival benefit. Less is known about induction chemotherapy followed by radical cystectomy in initially unresectable patients. Our retrospective analysis of a selected patient cohort suggests that patients with initially unresectable bladder cancer may benefit from this combined treatment approach. OBJECTIVE center dot To analyse the outcome in selected patients with initially unresectable or minimally metastatic muscle-invasive urothelial bladder cancer who underwent induction chemotherapy (IC) followed by radical cystectomy (RC). PATIENTS AND METHODS center dot Thirty patients with initially unresectable, locally advanced or minimally metastatic bladder cancer underwent platinum-based IC followed by RC with curative intent at our institution from 2000 to 2007. center dot They received a median of four cycles (range 2-6 cycles) of cisplatin and gemcitabine (n = 19), carboplatin and gemcitabine (n = 9) or other platinum combinations (n = 2). center dot We retrospectively analysed all 30 patients for complete pathological remission (pT0), disease free survival (DFS) and overall survival (OS). Chi-square tests, Kaplan-Meier analyses, and Cox univariate modelling were used. RESULTS center dot Before IC, 30 patients were deemed unresectable because of locally advanced tumour classification (cT4, 18/30) and/or clinically suspected lymph node (LN) metastasis (21/30) or suspected distant metastasis (3/30). center dot At re-staging after IC there was a complete regression of all enlarged LN in 16/21 patients, a partial LN response in one patient or stable LN size in the remaining four patients. center dot After RC, 9/30 (30%) of patients had attained pT0. center dot The median follow-up was 28 months (range 4-97 months). The 5-year DFS and OS rates were 42% and 46%, respectively, for all patients. center dot In the pT0 patients, the DFS (83%) and OS (71%) rates were significantly higher than in non-pT0 patients. CONCLUSION center dot Patients undergoing IC followed by RC showed encouraging response and survival rates, suggesting that selected patients with initially unresectable bladder cancer benefit from this combined regimen.