Introduction and Objectives
Neoadjuvant chemotherapy has previously been combined with radical cystectomy to improve survival from occult metastatic disease. The purpose of this study was to evaluate disease response to neoadjuvant Gemcitabine (Gem) and Cisplatin (Cis) chemotherapy in muscle-invasive TCC compared to muscle-invasive TCC with concomitant CIS.
Material and Methods
Over 5 years (2003–08), 60 patients (46 male 14 female) at 2 centres (FRH and JCUH) were administered 3–4 intravenous doses of Gem/Cis at 28 day intervals. Mean age was 68 years (50–78). Group 1 had T2 muscle-invasive disease (n = 34), and group 2 had T2 + CIS (n = 26). CT scans were repeated following chemotherapy. All 60 patients subsequently underwent radical cystectomy with lymph-node dissection and ileal conduit formation (55) or neobladder reconstruction (5).
Pathological and radiological responses were noted prospectively (see table).
|Total number of patients||Regression of disease (%)||No Change (%)||Progression of disease (%)|
|Group 1: T2||34||26 (76.4%)||5 (14.7%)||3 (8.8%)|
|Group 2: T2+CIS||26||7 (26.9%)||15 (57.7%)||4 (15.4%)|
|Group 1: T2||34||24 (70.6%)||7 (20.6%)||3 (8.8%)|
|Group 2: T2+CIS||26||6 (23.1%)||15 (57.7%)||5 (19.2%)|
Our results clearly show that the response of muscle-invasive TCC to Gem/Cis neoadjuvant chemotherapy is reduced in the presence of concomitant cis. Response rates to T2 disease alone are good, however, in excess of 70%. The role of neoadjuvant chemotherapy is to treat micro-metastastatic disease as well as the primary cancer. Our findings, suggest that the role of neoadjuvant chemotherapy in patients with concomitant cis is questionable. Further studies with greater numbers of patients and survival data are required.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.