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Japanese Journal of Clinical Oncology 30:553-556 (2000)
© 2000 Foundation for Promotion of Cancer Research

Preoperative Concurrent Chemoradiotherapy Against Muscle-invasive Bladder Cancer: Results of Partial Cystectomy in Elderly or High-risk Patients

Yukio Kageyama, Yohei Okada, Gaku Arai, Nobuhiko Hyochi, Masahito Suzuki, Hitoshi Masuda, Tetsuo Hayashi, Satoru Kawakami, Tetsuo Okuno, Kazuhiro Ishizaka and Kazunori Kihara+

Department of Urology and Reproductive Medicine, Graduate School Tokyo Medical and Dental University, Tokyo, Japan

Background: Good local control has been reported in cases of muscle-invasive bladder cancer treated by chemoradiotherapy and transurethral resection (TUR). However, definitive irradiation or extensive chemotherapy is often intolerable for elderly or poor-risk patients. We report here benefits of partial cystectomy after concurrent low-dose chemoradiotherapy for high-risk patients.

Methods: Thirty-seven patients with localized muscle-invasive bladder cancer (T2–T4) were treated with concurrent cisplatin (50–100 mg/body x 2 courses) and pelvic irradiation (40 Gy) preoperatively. Among 17 patients (46%) who achieved complete response (CR), 10 were not suitable for radical cystectomy and underwent partial cystectomy. Radical cystectomy was performed in 24 cases [CR = 6, partial response (PR) = 18]. Two patients (one CR and one PR) rejected open surgery and were treated by TUR of the primary site. One no change (NC) patient received no further treatment because of mental disorder.

Results: Median follow-up was 12 months (range 2–37 months). Fifteen of 36 evaluable cases (42%) achieved a pathological T0 response (no residual tumor). Estimated 3-year disease-free survival was 56% for all patients and 100% for T0 responders. Seven of 21 patients with pathological persistent tumor developed local recurrence (three patients) or distant metastasis (four patients). All of the 10 patients (eight with T0 response and two with a small residual tumor nest) who underwent partial cystectomy were recurrence-free for an observation period of up to 3 years.

Conclusions: Bladder preservation by partial cystectomy may be a choice for patients who show a good response to preoperative chemoradiotherapy and are not suitable for radical cystectomy.

+ For reprints and all correspondence: Yukio Kageyama, Department of Urology and Reproductive Medicine, Graduate School Tokyo Medical and Dental University, 1–5–45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan. E-mail: kageyys.uro@tmd.ac.jp


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I. Hara, H. Miyake, S. Hara, A. Gotoh, H. Okada, S. Arakawa, and S. Kamidono
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[Abstract] [Full Text] [PDF]


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