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POST-CHEMOTHERAPY SURGERY IN PATIENTS WITH UNRESECTABLE OR REGIONALLY METASTATIC BLADDER CANCER

Authors
Journal
The Journal of Urology
0022-5347
Publisher
Elsevier
Publication Date
Volume
165
Issue
3
Identifiers
DOI: 10.1016/s0022-5347(05)66533-0
Keywords
  • Bladder
  • Carcinoma
  • Transitional Cell
  • Drug Therapy
  • Neoplasm Metastasis
Disciplines
  • Biology
  • Medicine

Abstract

Purpose We update our experience with post-chemotherapy surgery in patients with unresectable or lymph node positive bladder cancer. Methods Of 207 patients with unresectable or regionally metastatic bladder cancer 80 (39%) underwent post-chemotherapy surgery after treatment with a cisplatin based chemotherapy regimen. We assessed the impact of surgery on achieving a complete response to chemotherapy and on relapse-free survival. Results No viable cancer was present at post-chemotherapy surgery in 24 of the 80 cases (30%), pathologically confirming a complete response to chemotherapy. Of the 24 patients 14 (58%) survived 9 months to 5 years. Residual viable cancer was completely resected in 49 patients (61%), resulting in a complete response to chemotherapy plus surgery, and 20 (41%) survived. Post-chemotherapy surgery did not benefit those who failed to achieve a major complete or partial response to chemotherapy. Only 1 of the 12 patients (8%) who refused surgery remains alive. Conclusions Post-chemotherapy surgical resection of residual cancer may result in disease-free survival in some patients who would otherwise die of disease. Optimal candidates include those in whom the pre-chemotherapy sites of disease are restricted to the bladder and pelvis or regional lymph nodes, and who have a major response to chemotherapy.

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