Login / register
Introduction
Radical treatment options for muscle invasive bladder cancer (MIBC) remain contentious. Patients can be treated with Radical cystectomy (RC), Radical radiotherapy (RT) or chemo-radiotherapy (CRT). No randomised evidence exists comparing these radical options. There is no level I evidence for Gemcitabine and Cisplatinum (GC) as neo-adjuvant chemotherapy.
Methods
Case notes of patients diagnosed with MIBC from a single NHS trust were reviewed. All patients received neo-adjuvant chemotherapy GC followed by radical treatment. Patients unsuitable for neoadjuvant chemotherapy were excluded.
Results
A total of 122 patients were reviewed. Median follow-up was 4.8 years (range 0.7-11.8 years). All patients were treated with fractionated GC chemotherapy (D1 & D8 / 3 weekly with Creatinine clearance (CrCl) up to 40mls/min). 25% of patients had a complete response & 2.6% progressed. A total of 17% patients were treated with RT, 22% were given CRT and 61% had RC. Recurrence rate was 38% and 56% patients were alive at the time of review. Definitive treatment did not significantly affect overall survival (OS)(p=0.16) or disease free interval (DFI) (p=0.74). The 5 year OS rates were 44% for those having RT, 54% for CRT and 55% for RC and 47%, 49% and 58% respectively for DFI.
Conclusion
GC is an effective neoadjuvant chemotherapy regimen for patients with MIBC. Based on this real life data, patients should be offered the choice of RT/CRT or RC.
