BOSTONA combination of transurethral resection (TUR)
and radiochemotherapy with cisplatin (Platinol) and fluorouracil (5-FU)
produced the most promising results in a German study of bladder-sparing
protocols for patients with invasive bladder cancer.
Thomas Brunner, MD, presented the study at the 42nd Annual
Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).
Researchers in the Department of Radiation Oncology,
Universität Erlangen-Nürnberg, Erlangen, Germany, evaluated prognostic
factors in 400 patients with invasive bladder cancer who received various
combinations of combined-modality therapy from 1982 to 1999.
The goal was to identify predictors of which patients would
most benefit from transurethral resection followed by radiotherapy with or
without concomitant platinum-based chemotherapy.
The patients received 54 to 59.4 Gy of radiation to the bladder
and 45 to 50 Gy to the regional lymph nodes and either no chemotherapy (137
patients) or chemotherapy (263 patients) during the first and fifth weeks of
radiotherapy. Chemotherapy consisted of carboplatin (Paraplatin) (97 patients),
cisplatin (127 patients), or cisplatin/5-FU (44 patients).
Dr. Brunner reported that the group as a whole had a 5-year
disease-specific survival rate of 52%, with 80% of the survivors maintaining
their bladder. The best results, a 5-year disease-specific survival rate of
77%, was achieved by the patients whose chemotherapy regimen included cisplatin
"Patients who receive platinum-based chemoradiation do
better," Dr. Brunner said, "and chemoradiation is better than
Another significant outcome, he said, was a metastasis-free
survival rate of 75% after 5 years for patients with residual invasive disease
who had cystectomy. "That means that salvage cystectomy really has a
curative intent," he said.
The study showed that the presence of tumor-associated
carcinoma in situ (CIS) and multifocality of the tumor were not associated with
poorer disease-specific survival. Dr. Brunner reported, however, that
"patients who had multifocal tumors had a significantly higher incidence
of invasive relapse than those with unifocal tumors."
Five-year disease-specific survival was poorer for patients
with lymphatic invasion43% vs 62% for those who did not have lymph node
Completeness of TUR, clinical stage, and tumor grade were all
significant prognostic factors. "It is obvious that smaller tumors do
better than bigger tumors and also that patients with complete resection do
better than patients with noncomplete resection," Dr. Brunner said.
A major concern is the 20% of patients who did not respond to
radiochemotherapy. The researchers hope to develop diagnostic tests to
identify these patients and the most effective treatment for each patient
group, he concluded, calling the current results "good, but not good