Concomitant chemotherapy/radiotherapy in inoperable locally advanced bladder cancer

The development of new treatment techniques, including concomitant chemotherapy/radiotherapy, appears to achieve higher response rates in advanced bladder cancer. Previous studies have suggested that continuous infusion chemotherapy and concomitant irradiation act synergistically to induce significantly increased tumour cell destruction. With the combination of 5FU and radiotherapy, the local control rate of transitional cell bladder cancers was 70% with a 5-year survival rate of 36% to 62%. Concomitant cisplatin and irradiation improved the control of locally advanced bladder cancers, but failed to improve overall survival. The use of concomitant cisplatin has no effect oil distant metastases. These treatment modalities require further evaluation because of the relationships between radiotherapy - and drug-induced apoptosis, delayed cell death, survival of clonogenic cells, clinical response and overall survival. The optimum concomitant chemotherapy/radiotherapy protocol has not yet been defined.