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Preliminary Results in Invasive Bladder Cancer with Transurethral Resection, Neoadjuvant Chemotherapy and Combined Pelvic Irradiation Plus Cisplatin Chemotherapy

1990; Lippincott Williams & Wilkins; Volume: 144; Issue: 5 Linguagem: Inglês

10.1016/s0022-5347(17)39674-x

1527-3792

George R. Prout, William U. Shipley, Donald S. Kaufman, Niall M. Heney, Pamela P. Griffin, Alex F. Althausen, Barbara Bassil, Barry N. Nocks, Edward C. Parkhurst, Hugh H. Young,

Renal cell carcinoma treatment

No AccessJournal of Urology1 Nov 1990Preliminary Results in Invasive Bladder Cancer with Transurethral Resection, Neoadjuvant Chemotherapy and Combined Pelvic Irradiation Plus Cisplatin Chemotherapy George R. Prout, William U. Shipley, Donald S. Kaufman, Niall M. Heney, Pamela P. Griffin, Alex F. Althausen, Barbara Bassil, Barry N. Nocks, Edward C. Parkhurst, and Hugh H. Young George R. ProutGeorge R. Prout More articles by this author , William U. ShipleyWilliam U. Shipley More articles by this author , Donald S. KaufmanDonald S. Kaufman More articles by this author , Niall M. HeneyNiall M. Heney More articles by this author , Pamela P. GriffinPamela P. Griffin More articles by this author , Alex F. AlthausenAlex F. Althausen More articles by this author , Barbara BassilBarbara Bassil More articles by this author , Barry N. NocksBarry N. Nocks More articles by this author , Edward C. ParkhurstEdward C. Parkhurst More articles by this author , and Hugh H. YoungHugh H. Young More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)39674-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Preliminary data are presented of a clinically feasible pilot study to select a significant subgroup of patients among those with muscle-invading bladder tumors for local cure and bladder preservation, while also to offer all patients the possibility of preventing the development of distant metastases. Transurethral debulking surgical resection was combined with neoadjuvant methotrexate, cisplatin and vinblastine chemotherapy plus 2 additional courses of cisplatin and 4,000cGy. If tumor was found on cystoscopic re-evaluation by biopsy and for cytology after cisplatin and partial irradiation (4,000cGy.) immediate cystectomy was advised. If tumor was not found consolidation by a radiotherapy boost to a total of 6,480cGy. plus 1 additional course of cisplatin was given. Of 53 consecutive patients the planned treatment was completed in 42 (79%). With a median followup of 26 months (range 15 to 42 months), 72% of all entered patients were alive, 70% have not required cystectomy and 74% have not had distant metastases. Among the 42 patients who completed the planned protocol chemotherapy dose reductions were required in 39% for stomatitis, bone marrow depression and/or renal dysfunction. There were 2 serious complications but no treatment-related sepsis, deaths or significant renal dysfunction. Eight patients underwent immediate radical cystectomy because of positive biopsy and/or cytology results after 4,000cGy., while 34 completed full chemotherapy and radiotherapy without any significant bladder or bowel injury. Of 42 patients 22 (52%) have maintained the bladder without any recurrence, and of those selected for full chemotherapy and radiotherapy this number increased to 65%. To date 12 patients have persistent or recurrent bladder tumors: 5 (15%) had invasive tumors treated by cystectomy and 7 (21%) had carcinoma in situ treated by intravesical therapy. The true success of this or other selective bladder-preserving treatments will require 3 to 5 years of followup to be confident that such treatment has sterilized the bladder of cancer. This feasibility study has been clinically practical, modestly well tolerated and encouraging for the significant proportion of patients with a sustained complete response and for the 70% over-all survival rate at 2 years. To evaluate critically the efficacy of methotrexate, cisplatin and vinblastine chemotherapy in the prevention of occult distant micrometastases and in increasing the rate of successful bladder preservation, in May 1988 we began a randomized phase 3 trial with and without neoadjuvant methotrexate, cisplatin and vinblastine chemotherapy. (J. Urol., 144: 1128–1136, 1990) © 1990 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByEAPEN L, STEWART D, COLLINS J and PETERSON R (2018) EFFECTIVE BLADDER SPARING THERAPY WITH INTRA-ARTERIAL CISPLATIN AND RADIOTHERAPY FOR LOCALIZED BLADDER CANCERJournal of Urology, VOL. 172, NO. 4 Part 1, (1276-1280), Online publication date: 1-Oct-2004.SHIPLEY W, KAUFMAN D, HENEY N, ALTHAUSEN A and ZIETMAN A (2018) AN UPDATE OF COMBINED MODALITY THERAPY FOR PATIENTS WITH MUSCLE INVADING BLADDER CANCER USING SELECTIVE BLADDER PRESERVATION OR CYSTECTOMYJournal of Urology, VOL. 162, NO. 2, (445-450), Online publication date: 1-Aug-1999.Martinez-Pineiro J, Martin M, Arocena F, Flores N, Roncero C, Portillo J, Escudero A, Cruz F and Isorna S (2018) Original Articles: Bladder Cancer: Neoadjuvant Cisplatin Chemotherapy Before Radical Cystectomy in Invasive Transitional Cell Carcinoma of the Bladder: A Prospective Randomized Phase III StudyJournal of Urology, VOL. 153, NO. 3S, (964-973), Online publication date: 1-Mar-1995.Sumiyoshi Y, Yokota K, Akiyama M, Inoue Y, Yoneda F, Tsujimura H, Nakajima M, Yokozeki H and Maebayashi K (2018) Neoadjuvant Intra-Arterial Doxorubicin Chemotherapy in Combination with Low Dose Radiotherapy for the Treatment of Locally Advanced Transitional Cell Carcinoma of the BladderJournal of Urology, VOL. 152, NO. 2 Part 1, (362-366), Online publication date: 1-Aug-1994.Vikram B, Malamud S, Silverman P, Hecht H and Grabstald H (2018) A Pilot Study of Chemotherapy Alternating with Twice-a-Day Accelerated Radiation Therapy as an Alternative to Cystectomy in Muscle Infiltrating (Stages T2 and T3) Cancer of the Bladder: Preliminary ResultsJournal of Urology, VOL. 151, NO. 3, (602-604), Online publication date: 1-Mar-1994.Thrasher J and Crawford E (2018) Current Management of Invasive and Metastatic Transitional Cell Carcinoma of the BladderJournal of Urology, VOL. 149, NO. 5 Part 1, (957-972), Online publication date: 1-May-1993.Hug E, Donnelly S, Shipley W, Heney N, Kaufman D, Preffer F, Schwartz S, Colvin R and Althausen A (2018) Deoxyribonucleic Acid Flow Cytometry in Invasive Bladder Carcinoma: A Possible Predictor for Successful Bladder Preservation following Transurethral Surgery and Chemotherapy-RadiotherapyJournal of Urology, VOL. 148, NO. 1, (47-51), Online publication date: 1-Jul-1992. Volume 144Issue 5November 1990Page: 1128-1134 Advertisement Copyright & Permissions© 1990 by The American Urological Association Education and Research, Inc.MetricsAuthor Information George R. Prout More articles by this author William U. Shipley More articles by this author Donald S. Kaufman More articles by this author Niall M. Heney More articles by this author Pamela P. Griffin More articles by this author Alex F. Althausen More articles by this author Barbara Bassil More articles by this author Barry N. Nocks More articles by this author Edward C. Parkhurst More articles by this author Hugh H. Young More articles by this author Expand All Advertisement Loading ...