The Efficacy of Bimodality Therapy for Organ Preservation in Locally Advanced Bladder Tumor.
- Author:
Dong Jin YOON
1
;
Young Joo KIM
;
Sung Goo CHANG
Author Information
1. Department of Urology, School of Medicine, Kyung Hee University, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Bladder tumor;
Cheomtherapy;
Organ preservation
- MeSH:
Biopsy;
Cisplatin;
Cystectomy;
Doxorubicin;
Drug Therapy;
Epirubicin;
Follow-Up Studies;
Humans;
Hydronephrosis;
Magnetic Resonance Imaging;
Organ Preservation*;
Survival Rate;
Urinary Bladder Neoplasms*;
Urinary Bladder*;
Vinblastine
- From:Korean Journal of Urology
2004;45(2):97-102
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We evaluate the efficacy of bimodality therapy for organ preservation in locally advanced bladder tumors. MATERIALS AND METHODS: A total of 23 patients with a clinical stage T2- T4aN0M0 bladder tumor were included in our study and treated with transurethral resection or partial cystectomy by chemotherapy. They are composed of T2: 6, T3: 11, T4a: 6 cases in stage, W.H.O. LMP (low malignant potencial): 1, low grade: 9, high grade: 13 cases in pathologic grade. The followed chemotherapy regimens were composed of M-VAC (methotrexate 30mg/m2, vinblastine 3mg/m2, adriamycin 30mg/m2, cisplatin 70mg/m2), S-MEC (methotrexate 30mg/m2, epirubicin 50mg/m2, cisplatin 100mg/ m2), and gemcitabine (100mg/m2)-cisplatin (70mg/m2) in 10, 8, and 5 cases, respectively. The evaluation of response was performed by transurethral biopsy, urine cytology, CT, and MRI after more than 4 cycles of postoperative chemotherapy. RESULTS: A complete response was achieved in 10 patients (43.5%), and a partial response occurred in 3 patients (13.0%) to give an overall response rate of 56.5%. The mean duration of complete responses was 35.5 months. Eight of 23 patients are still alive. The mean duration of the follow-up was 41.6 months, and their 5-year survival rate was 33.3%. Low stage, initial response to therapy, and no evidence of hydronephrosis were all significant predictors for an increased probability of organ preservation. CONCLUSIONS: Transurethral resection or partial cystectomy followed by chemotherapy result in long-term bladder preservation in a significant proportion of responding patients, and may be a comparable therapy to trimodality therapy in select patients in locally advanced bladder tumors.
