Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2020; 09(03): 121-125
DOI: 10.1055/s-0041-1723076
Original Article: Bladder Cancer

Bladder Preservation with Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiation for the Treatment of Muscle-invasive Carcinoma of the Bladder: A Single-Center Experience

Chinmayee Agrawal
1   Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
,
Saurabh Bansal
1   Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
,
Manoj Biswas
2   Department of General Surgery, HIMS, SRHU, Dehradun, Uttarakhand, India
,
Meenu Gupta
1   Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
,
Vipul Nautiyal
1   Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
,
Mushtaq Ahmed
1   Department of Radiation Oncology, Cancer Research Institute, SRHU, Dehradun, Uttarakhand, India
› Author Affiliations Financial Support and Sponsorship Nil.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Purpose The purpose of the study was to evaluate the short-term response and acute toxicities in muscle-invasive carcinoma urinary bladder treated with neoadjuvant chemotherapy followed by concurrent chemoradiation.

Materials and Methods Thirty patients with muscle-invasive bladder cancer were treated with three cycles of neoadjuvant chemotherapy every 3 weeks. Response assessment was done after 4 weeks with repeat cystoscopy and imaging. Responders were treated with concurrent chemoradiation 60 Gy/30# at 2 Gy/# along with weekly injection cisplatin 35 mg/m2. Response assessment was done by new response evaluation criteria in solid tumors (version 1.1). Treatment-related acute toxicities were scored using common terminology criteria for adverse events version 4.0.

Results Of the 30 patients, 25 patients responded to neoadjuvant chemotherapy with complete response in 17 patients (56.67%) and partial response in eight patients (26.66%). Five patients (16.66%) showed poor response and were advised radical cystectomy, of which four underwent radical cystectomy and one patient opted for concurrent chemoradiation. Of 26 patients who completed chemoradiation, complete response was seen in 21 patients (80.76%) and partial response was seen in four patients (15.38%). Only one patient developed progression of disease in the form of lung metastasis. All the patients with residual disease were advised to undergo salvage cystectomy. Among the patients receiving chemoradiation, grade 2 cystitis and diarrhea was seen in 10 patients (38.46%) and four patients (15.38%), respectively. Only one patient developed grade 3 diarrhea.

Conclusion Bladder preservation treatment is an effective, safe, and convenient option for patients presenting with muscle-invasive carcinoma bladder. Neoadjuvant chemotherapy followed by chemoradiation was well-tolerated with an acceptable rate of complications.

Keywords

bladder preservation - muscle-invasive bladder cancer - neoadjuvant chemotherapy


Publication History

Article published online:
26 April 2021

© 2020. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Rene NJ, Cury FB, Souhami L. Conservative treatment of invasive bladder cancer. Curr Oncol 2009; 16 (04) 36-47
    CrossrefPubMedSearch in Google Scholar
  • 2 Balar A, Bajorin DF, Milowsky MI. Management of invasive bladder cancer in patients who are not candidates for or decline cystectomy. Ther Adv Urol 2011; 3 (03) 107-117
    CrossrefPubMedSearch in Google Scholar
  • 3 Zhang S, Yu YH, Zhang Y, Qu W, Li J. Radiotherapy in muscle-invasive bladder cancer: the latest research progress and clinical application. Am J Cancer Res 2015; 5 (02) 854-868
    PubMedSearch in Google Scholar
  • 4 Bellmunt J, Orsola A, Leow JJ, Wiegel T, De Santis M, Horwich A. ESMO Guidelines Working Group. Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 (Suppl. 03) iii40-iii48
    CrossrefPubMedSearch in Google Scholar
  • 5 Stein JP, Lieskovsky G, Cote R. et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001; 19 (03) 666-675
    CrossrefPubMedSearch in Google Scholar
  • 6 Beena K, Nambiar VR, Dinesh M. Tri-modality treatment in muscle invasive bladder cancer - What is the current status. Amrita J Med 2013; 9: 14-21
    Search in Google Scholar
  • 7 Hafeez S, Horwich A, Omar O. et al. Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder. Br J Cancer 2015; 112 (10) 1626-1635
    CrossrefPubMedSearch in Google Scholar
  • 8 Tunio MA, Asiri MA, Fareed M. et al. Bladder preservation with concurrent radiotherapy and gemcitabine following maximal transurethral resection for muscle invasive bladder cancer: single institutional experience. J Nucl Med Radiat Ther 2012; 3: 121-128
    CrossrefSearch in Google Scholar
  • 9 Grossman HB, Natale RB, Tangen CM. et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003; 349 (09) 859-866
    CrossrefPubMedSearch in Google Scholar
  • 10 Sternberg CN, Yagoda A, Scher HI. et al. Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium. J Urol 1985; 133 (03) 403-407
    CrossrefPubMedSearch in Google Scholar
  • 11 Fernando SA, Sandler HM. Organ preservation in muscle-invasive bladder cancer. Oncology (Williston Park) 2005; 19 (03) 334-339–353
    Search in Google Scholar
  • 12 Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 2005; 48 (02) 202-205–206
    CrossrefPubMedSearch in Google Scholar
  • 13 Perdonà S, Autorino R, Damiano R. et al. Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer: a multi-institutional, long-term experience. Cancer 2008; 112 (01) 75-83
    CrossrefPubMedSearch in Google Scholar
  • 14 Mitin T, George A, Zietman AL. et al. Long-term outcomes among patients who achieve complete or near-complete responses after the induction phase of bladder-preserving combined-modality therapy for muscle-invasive bladder cancer: A pooled analysis of NRG oncology/RTOG 9906 and 0233. Int J Radiat Oncol Biol Phys 2016; 94 (01) 67-74
    CrossrefPubMedSearch in Google Scholar
  • 15 Tunio MA, Hashmi A, Rafi M, Qayyum A, Masood R. Bladder preservation by neoadjuvant chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer: experience at Sindh Institute of Urology & Transplantation (SIUT). J Pak Med Assoc 2011; 61 (01) 6-10
    PubMedSearch in Google Scholar
  • 16 Sabaa MA, El-Gamal OM, Abo-Elenen M, Khanam A. Combined modality treatment with bladder preservation for muscle invasive bladder cancer. Urol Oncol 2010; 28 (01) 14-20
    CrossrefPubMedSearch in Google Scholar
  • 17 Sadzikowska JN, Kowalska T, Jakubowicz J, Szpytma T. Conservative treatment in patients with muscle-invasive bladder cancer by transurethral resection, neoadjuvant chemotherapy with gemcitabine and cisplatin, and accelerated radiotherapy with concomitant boost plus concurrent cisplatin assessment of response and toxicity. Rep Pract Oncol Radiother 2008; 13: 300-308
    CrossrefSearch in Google Scholar