Outcomes with surgery or radiotherapy following neoadjuvant chemotherapy for bladder cancer at the Edinburgh Cancer Centre


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Joanna Mackenzie1, Jahangeer Malik1, Gill Kerr1, Duncan McLaren1, Alastair Law1
1Edinburgh Cancer Centre, Edinburgh, UK

Background

Neoadjuvant platinum-based chemotherapy for muscle invasive bladder cancer (MIBC) confers a 5% overall survival benefit at 5 years in addition to local pelvic treatment.1

Method

We have retrospectively reviewed the outcomes of patients with MIBC treated with neoadjuvant Cisplatin and Gemcitabine chemotherapy between 2004 and 2009, followed by either definitive bladder radiotherapy or radical cystectomy.

Results

67 patients with a median age of 63 years (range 28-73) and 79% (n=53) male were reviewed. The median follow up period was 4 years (range 2-6.8 years). 95.5% (n=64) of patients had G3pT2/3 cancers. 7.5% (n=5) had node positive disease on initial staging. 4.5% (n=3) had T4 disease. All 67 patients received at least 1 cycle of chemotherapy (range 1-4). Patients were assessed after Cycle 3 with either a check cystoscopy, CT or MRI scan. The response rate was 83.6%. 65 (97%) patients went on to have further treatment after chemotherapy with 64.6% undergoing cystectomy and 35.4% having bladder radiotherapy. 25 patients developed recurrent disease (37.3%) with 48% in the surgery group and 52% in the radiotherapy group. The rates of local and distant relapse in both groups were similar. The progression free survival at 5 years was not significantly different (p=0.68) between those patients receiving radiotherapy and those having surgery at 55.4% and 62.9%, respectively. Patients with lower T stage disease had significantly better progression free survival and relapse rates (p<0.001 for both). More than half of the patients were still alive and not relapsed at 4 years so the median survival cannot be estimated.

Conclusion

This retrospective case series demonstrates similar outcomes for cystectomy and bladder radiotherapy in patients treated with platinum-based neoadjuvant chemotherapy. The 5 year PFS in both groups is comparable with previously reported 5 year survival in surgical case series.2