Induction chemotherapy for unresectable urothelial carcinoma of the bladder.

Objective: • To analyse the outcome in selected patients with initially unresectable or minimally metastatic muscle-invasive urothelial bladder cancer who underwent induction chemotherapy (IC) followed by radical cystectomy (RC).

Methods: • Thirty patients with initially unresectable, locally advanced or minimally metastatic bladder cancer underwent platinum-based IC followed by RC with curative intent at our institution from 2000 to 2007. • They received a median of four cycles (range 2-6 cycles) of cisplatin and gemcitabine (n= 19), carboplatin and gemcitabine (n= 9) or other platinum combinations (n= 2). • We retrospectively analysed all 30 patients for complete pathological remission (pT0), disease free survival (DFS) and overall survival (OS). Chi-square tests, Kaplan-Meier analyses, and Cox univariate modelling were used.

Results: • Before IC, 30 patients were deemed unresectable because of locally advanced tumour classification (cT4, 18/30) and/or clinically suspected lymph node (LN) metastasis (21/30) or suspected distant metastasis (3/30). • At re-staging after IC there was a complete regression of all enlarged LN in 16/21 patients, a partial LN response in one patient or stable LN size in the remaining four patients. • After RC, 9/30 (30%) of patients had attained pT0. • The median follow-up was 28 months (range 4-97 months). The 5-year DFS and OS rates were 42% and 46%, respectively, for all patients. • In the pT0 patients, the DFS (83%) and OS (71%) rates were significantly higher than in non-pT0 patients.

Conclusions: • Patients undergoing IC followed by RC showed encouraging response and survival rates, suggesting that selected patients with initially unresectable bladder cancer benefit from this combined regimen.