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Combined chemotherapy and external beam radiotherapy for transitional cell carcinoma of the bladder

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Abstract

A growing body of evidence supports the treatment of invasive transitional cell carcinoma of the bladder with transurethral resection, chemotherapy, and external beam radiotherapy. Randomized trials have demonstrated the superiority of chemotherapy plus radiotherapy to radiotherapy alone. Several series with 10 years of follow-up demonstrate that the success of this approach can be maintained. Preservation of the urothelium, however, results in continued risk of de novo bladder cancer development in addition to the possibility of recurrence. Thus, continued close surveillance and treatment of subsequent superficial or invasive bladder cancer is an essential component of this bladder preservation approach. Concomitant cisplatin chemotherapy and radiotherapy or initial (neoadjuvant) combination cisplatin-based chemotherapy followed by radiotherapy are the two options best supported by the literature. How these regimens compare with each other and with cystectomy-based treatment remains to be defined.

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References and Recommended Reading

  1. Fossa S, Waehre H, Aass N, et al.: Bladder cancer definitive radiation therapy of muscle-invasive bladder cancer. Cancer 1993, 72:3036–3043.

    Article  PubMed  CAS  Google Scholar 

  2. Yu W, Sagerman R, Chung C, et al.: Bladder carcinoma: experience with radical and preoperative radiotherapy in 421 patients. Cancer 1985, 56:1293–1299.

    Article  PubMed  CAS  Google Scholar 

  3. Goffinet D, Schneider M, Glatstein E, et al.: Bladder cancer: results of radiation therapy in 384 patients. Radiology 1975, 117:149–153.

    PubMed  CAS  Google Scholar 

  4. Greven K, Solin L, Hanks G: Prognostic factors in patients with bladder carcinoma treated with definitive irradiation. Cancer 1990, 65:908–912.

    Article  PubMed  CAS  Google Scholar 

  5. Duncan W, Quilty P: The results of a series of 963 patients with transitional cell carcinoma of the urinary bladder primarily treated by radical megavoltage x-ray therapy. Radiother Oncol 1986, 7:299–310.

    Article  PubMed  CAS  Google Scholar 

  6. Quilty P, Duncan W: Primary radical radiotherapy for T3 transitional cell cancer of the bladder: an analysis of survival and control. Int J Radiat Oncol Biol Phys 1986, 12:853–860.

    PubMed  CAS  Google Scholar 

  7. Shipley W, Prout G, Kaufman S, Perrone T: Invasive bladder carcinoma: the importance of initial transurethral surgery and other prognostic factors for improved survival with fulldose irradiation. Cancer 1987, 60:514–520.

    Article  PubMed  CAS  Google Scholar 

  8. Gospodarowicz M, Hawkins N, Rawlings G, et al.: Radical radiotherapy for muscle invasive transitional cell carcinoma of the bladder: failure analysis. J Urol 1989, 142:1448–1454.

    PubMed  CAS  Google Scholar 

  9. Goodman G, Hislop T, Elwood J, Balfour J: Conservation of bladder function in patients with invasive bladder cancer treated by definitive irradiation and selective cystectomy. Int J Radiat Oncol Biol Phys 1981, 7:569–573.

    PubMed  CAS  Google Scholar 

  10. Pollack A, Zagars G, Swanson D: Muscle-invasive cancer treated with external beam radiotherapy: prognostic factors. Int J Radiat Oncol Biol Phys 1994, 30:267–277.

    PubMed  CAS  Google Scholar 

  11. Shipley W, Kaufman D, Heney N: Opportunities for bladder preservation in patients with localized invasive cancer using multimodality therapy. Princ Pract Oncol Updates 1990, 4:1–9.

    Google Scholar 

  12. Coppin C, Gospodarowicz M, James K, et al.: Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. J Clin Oncol 1996, 14:2901–2907. Only randomized trial of concomitant chemotherapy and radiotherapy.

    PubMed  CAS  Google Scholar 

  13. Sauer R, Schrott K, Dunst J: Carcinoma with radiotherapy and cisplatin. Int J Radiat Oncol Biol Phys 1988, 15:871–875.

    PubMed  CAS  Google Scholar 

  14. Sauer R, Dunst J, Altendorf-Hofmann A, et al.: Radiotherapy with and without cisplatin in bladder cancer. Int J Radiat Oncol Biol Phys 1990, 19:687–691.

    PubMed  CAS  Google Scholar 

  15. Dunst J, Schrott K, Sauer R: Definitive radiotherapy in bladder cancer. Int J Radiat Oncol Biol Phys 1993, 27:217.

    Google Scholar 

  16. Sauer R, Birkenhake S, Kuhn R, et al.: Efficacy of radiochemotherapy with platin derivatives compared to radiotherapy alone in organ-sparing treatment of bladder cancer. Int J Radiat Oncol Biol Phys 1998, 40:121–127.

    Article  PubMed  CAS  Google Scholar 

  17. Rodel C, Grabenbauer GG, Kuhn R, et al.: Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol 2002, 20:3061–3071. Largest prospective trial of concomitant chemotherapy and radiotherapy.

    Article  PubMed  Google Scholar 

  18. Rodel C, Grabenbauer GG, Kuhn R, et al.: Organ preservation in patients with invasive bladder cancer: initial results of an intensified protocol of transurethral surgery and radiation therapy plus concurrent cisplatin and 5-fluorouracil. Int J Radiat Oncol Biol Phys 2002, 52:1303–1309.

    Article  PubMed  CAS  Google Scholar 

  19. 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, 19:666–675.

    PubMed  CAS  Google Scholar 

  20. Bassi P, Ferrante GD, Piazza N, et al.: Prognostic factors of outcome after radical cystectomy for bladder cancer: a retrospective study of a homogeneous patient cohort. J Urol 1999, 161:1494–1497.

    Article  PubMed  CAS  Google Scholar 

  21. Cheng L, Weaver AL, Leibovich BC, et al.: Predicting the survival of bladder carcinoma patients treated with radical cystectomy. Cancer 2000, 88:2326–2332.

    Article  PubMed  CAS  Google Scholar 

  22. Tester W, Porter A, Asbell S, et al.: Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85–12. Int J Radiat Oncol Biol Phys 1993, 25:783–790.

    PubMed  CAS  Google Scholar 

  23. Edland R, Wear J, Ansfield F: Advanced cancer of the urinary bladder. J Urol 1970, 108:124–129.

    CAS  Google Scholar 

  24. Krook J, Moertel C, Gunderson L, et al.: Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med 1991, 325:519–520.

    Article  Google Scholar 

  25. Moertel CG, Frytak S, Hahn RG, et al.: Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. Cancer 1981, 48:1705–1710.

    Article  PubMed  CAS  Google Scholar 

  26. Chen W-C, Liaw C-C, Chuang C-K, et al.: Concurrent cisplatin, 5-fluorouracil, leucovorin, and radiotherapy for invasive bladder cancer. Int J Radiat Oncol Biol Phys 2003, 56:726–733.

    Article  PubMed  CAS  Google Scholar 

  27. Housset M, Maulard C, Chretien Y, et al.: Combined radiation the bladder: a prospective study. J Clin Oncol 1993, 11:2150–2157.

    PubMed  CAS  Google Scholar 

  28. Kaufman DS, Winter KA, Shipley WU, et al.: The initial results in muscle-invading bladder cancer of RTOG 95-06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5-fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist 2000, 5:471–476.

    Article  PubMed  CAS  Google Scholar 

  29. International Collaboration of Trialists: Neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscleinvasive bladder cancer: a randomised controlled trial. Lancet 1999, 354:533–540.

    Article  Google Scholar 

  30. Wallace D, Raghavan D, Kelly K, et al.: Neo-adjuvant (preemptive) cisplatin therapy in invasive transitional cell carcinoma of the bladder. Br J Urol 1991, 67:608–615.

    Article  PubMed  CAS  Google Scholar 

  31. Sengelov L, von der Maase H, Lundbeck F, et al.: Neoadjuvant chemotherapy with cisplatin and methotrexate in patients with muscle-invasive bladder tumors. Acta Oncol 2002, 41:447–456.

    Article  PubMed  CAS  Google Scholar 

  32. Advanced Bladder Cancer (ABC) Meta-analysis Collaboration: Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003, 361:1927–1934. Meta-analysis that established a survival advantage to neoadjuvant chemotherapy prior to definitive local treatment.

    Article  CAS  Google Scholar 

  33. 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, 349:859–866.

    Article  PubMed  CAS  Google Scholar 

  34. Shipley W, Prout G, Einstein A, et al.: Treatment of invasive bladder cancer by cisplatin and radiation in patients unsuited for surgery. JAMA 1987, 258:931–935.

    Article  PubMed  CAS  Google Scholar 

  35. Tester W, Caplan R, Heaney J, et al.: Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802. J Clin Oncol 1996, 14:119–126.

    PubMed  CAS  Google Scholar 

  36. Kachnic L, Kaufman D, Heney N, et al.: Bladder preservation by combined modality therapy for invasive bladder cancer. J Clin Oncol 1997, 15:1022–1029.

    PubMed  CAS  Google Scholar 

  37. Shipley W, Winter K, Kaufman D, et al.: Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol 1998, 16:3576–3583.

    PubMed  CAS  Google Scholar 

  38. Hussain MHA, Glass TR, Forman J, et al.: Combination cisplatin, 5-fluorouracil and radiation therapy for locally advanced unresectable or medically unfit bladder cancer cases: a Southwest Oncology Group study. J Urol 2001, 165:56–61.

    Article  PubMed  CAS  Google Scholar 

  39. Saunders M, Dische S, Barrett A, et al.: Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomized multicentre trial. Lancet 1997, 350:161–165.

    Article  PubMed  CAS  Google Scholar 

  40. Horoit J-C, Bontemps P, van den Bogaert W, et al.: Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. Radiother Oncol 1997, 44:111–121.

    Article  Google Scholar 

  41. De Neve W, Lybeert MLM, Goor C, et al.: Radiotherapy for T2 and T3 carcinoma of the bladder: the influence of overall treatment time. Radiother Oncol 1995, 36:183–188.

    Article  PubMed  Google Scholar 

  42. Maciejewski B, Majewski S: Dose fractionation and tumor repopulation in radiotherapy for bladder cancer. Radiother Oncol 1991, 21:163–170.

    Article  PubMed  CAS  Google Scholar 

  43. Edsmyr F, Andersson L, Esposti P, et al.: Irradiation therapy with multiple small fractions per day in urinary bladder cancer. Radiother Oncol 1985, 4:197–203.

    Article  PubMed  CAS  Google Scholar 

  44. Naslund I, Nilsson B, Littbrand B: Hyperfractionated radiotherapy of bladder cancer. Acta Oncol 1994, 33:397–402.

    PubMed  CAS  Google Scholar 

  45. Zietman AL, Shipley WU, Kaufman DS, et al.: A phase I/II trial of transurethral surgery combined with concurrent cisplatin, 5-fluorouracil and twice daily radiation followed by selective bladder preservation in operable patients with muscle invading bladder cancer. J Urol 1998, 160:1673–1677.

    Article  PubMed  CAS  Google Scholar 

  46. Hagan MP, Winter KA, Kaufman DS, et al.: RTOG 97-06: Initial report of a phase I-II trial of selective bladder conservation using Turbt, twice-daily accelerated irradiation sensitized with cisplatin, and adjuvant MCV combination chemotherapy. Int J Radiat Oncol Biol Phys 2003, 57:665–672.

    Article  PubMed  Google Scholar 

  47. Eapen L, Stewart D, Crook J, et al.: Intraarterial cisplatin and concurrent radiation in the management of muscle invasive bladder cancer. Int J Radiat Oncol Biol Phys 1992, 24:211.

    Google Scholar 

  48. Eapen L, Danjoux C, Genest P, et al.: Intra-arterial cisplatin and concurrent radiation for locally advanced bladder cancer. J Clin Oncol 1989, 7:230–235.

    PubMed  CAS  Google Scholar 

  49. Miyanaga N, Akaza H, Okumura T, et al.: A bladder preservation regimen using intra-arterial chemotherapy and radiotherapy for invasive bladder cancer: a prospective study. Int J Urol 2000, 7:41–48.

    Article  PubMed  CAS  Google Scholar 

  50. Mokarim A, Uetani M, Hayashi N, et al.: Combined intraarterial chemotherapy and radiotherapy in the treatment of bladder carcinoma. Cancer 1997, 80:1776–1785.

    Article  PubMed  CAS  Google Scholar 

  51. Tsukamoto S, Ishikawa S, Tsutsumi M, et al.: An organ-sparing treatment using combined intra-arterial chemotherapy and radiotherapy for muscle-invading bladder carcinoma. Scand J Urol Nephrol 2002, 36:339–343.

    Article  PubMed  Google Scholar 

  52. Hoshi S, Shintaku I, Suzuki K-I, et al.: Bladder preservation by internal iliac arterial infusion chemotherapy and irradiation in T3 bladder carcinoma patients over the age of 70 years. Tohoku J Exp Med 2000, 192:249–258.

    Article  PubMed  CAS  Google Scholar 

  53. Hoskin PJ, Saunders MI, Dische S: Hypoxic Radiosensitizers in radical radiotherapy for patients with bladder cancer. Cancer 1999, 86:1322–1328.

    Article  PubMed  CAS  Google Scholar 

  54. Rostom YA, Chapet O, Russo SM, et al.: Intra-operative electron radiotherapy as a conservative treatment for infiltrating bladder cancer. Eur J Cancer 2000, 36:1781–1787.

    Article  PubMed  CAS  Google Scholar 

  55. Hussain SA, Moffitt DD, Glaholm JG, et al.: A phase I-II study of synchronous chemoradiotherapy for poor prognosis locally advanced bladder cancer. Ann Oncol 2001, 12:929–935.

    Article  PubMed  CAS  Google Scholar 

  56. Goonewardene TI, Bozcuk H, Oliver RTD, et al.: Phase 1/2 study of synchronous methotrexate, cisplatin, vincristine (MOPq10) chemotherapy and radiation for patients with locally advanced bladder cancer. Urol Int 2001, 67:293–297.

    Article  PubMed  CAS  Google Scholar 

  57. Nichols RC, Sweetser MG, Mahmood SK, et al.: Radiation therapy and concomitant paclitaxel/carboplatin chemotherapy for muscle invasive transitional cell carcinoma of the bladder: a well-tolerated combination. Int J Cancer (Radiat Oncol Invest) 2000, 90:281–286.

    Article  CAS  Google Scholar 

  58. Serretta V, Lo Greco G, Pavone C, Pavone-Macaluso M: The fate of patients with locally advanced bladder cancer treated conservatively with neoadjuvant chemotherapy, extensive transurethral resection and radiotherapy: 10-year experience. J Urol 1998, 159:1187–1191.

    Article  PubMed  CAS  Google Scholar 

  59. Shipley WU, Kaufman DS, Zehr E, et al.: Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer. Urology 2002, 60:62–68. Long-term results of the pioneering work of the Massachusetts General Hospital.

    Article  PubMed  CAS  Google Scholar 

  60. Scrimger RA, Murtha AD, Parliament MB, et al.: Muscleinvasive transitional cell carcinoma of the urinary bladder: a population-based study of patterns of care and prognostic factors. Int J Radiat Oncol Biol Phys 2001, 51:23–30.

    Article  PubMed  CAS  Google Scholar 

  61. Zietman AL, Grocela J, Zehr E, et al.: Selective bladder conservation using transurethral resection, chemotherapy, and radiation: management and consequences of Ta, T1, and Tis recurrence within the retained bladder. Urology 2001, 58:380–385.

    Article  PubMed  CAS  Google Scholar 

  62. von der Maase H, Hansen SW, Roberts JT, et al.: Gemcitabine and cisplatin versus methotrexate, vinblastine doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter phase III Study. J Clin Oncol 2000, 17:3068–3077.

    Google Scholar 

  63. Bellmunt J, Hussain M, Dinney CP: Novel approaches with targeted therapies in bladder cancer: therapy of bladder cancer by blockade of the epidermal growth factor receptor family. Crit Rev Oncol Hematol 2003, 46(Suppl):S85-S104.

    PubMed  Google Scholar 

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  1. Department of Radiation Oncology, College of Physicians and Surgeons of Columbia University, 622 West 168th Street, BHN-Room B11, 10032, New York, NY, USA

    Ronald D. Ennis MD

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Ennis, R.D. Combined chemotherapy and external beam radiotherapy for transitional cell carcinoma of the bladder. Curr Oncol Rep 6, 230–236 (2004). https://doi.org/10.1007/s11912-004-0054-x

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