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N43 Is Carcinoma In Situ (CIS), a contra-indication for neoadjuvant chemotherapy for Transitional Cell Carcinoma (TCC) of the bladder?

      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).

      Results

      Pathological and radiological responses were noted prospectively (see table).
      Tabled 1
      Total number of patientsRegression of disease (%)No Change (%)Progression of disease (%)
      Histological
      Group 1: T23426 (76.4%)5 (14.7%)3 (8.8%)
      Group 2: T2+CIS267 (26.9%)15 (57.7%)4 (15.4%)
      Radiological
      Group 1: T23424 (70.6%)7 (20.6%)3 (8.8%)
      Group 2: T2+CIS266 (23.1%)15 (57.7%)5 (19.2%)

      Conclusions

      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.