CONCURRENT CISPLATIN AND RADIOTHERAPY FOR PATIENTS WITH MUSCLE INVASIVE BLADDER-CANCER WHO ARE NOT CANDIDATES FOR RADICAL CYSTECTOMY

Purpose: We assessed the results and prognostic factors in patients wi th bladder cancer treated conservatively with concurrent cisplatin and radiotherapy. Materials and Methods: A total of 109 patients with loc alized muscle invasive bladder cancer who were not candidates for radi cal cystectomy underwent concomitant chemotherapy and radiation. Media n patient age was 70 years. Of the patients 36% had stages T3B and 4 t umors, and 37% had benefited from prior macroscopically complete trans urethral resection. Pelvic irradiation consisted of 40 to 45 Gy., and was followed by a boost to the bladder to a total dose of 55 to 60 Gy. Continuous infusion cisplatin (20 to 25 mg./m.(2) daily for 5 days) w as delivered during weeks 2 and 5 of radiation therapy. Results: Media n followup was 54.8 months. The projected 4-year locoregional. control rate was 47.6% for the 109 patients and 61.2% for 76 with a complete response. Projected overall 4-year survival was 41.9% for all patients and 51.4% for complete responders. Univariate analysis of prognostic factors was done for local control. and survival. Local control was st atistically better in patients with a good performance status, stages T2 and 3A disease, complete initial transurethral resection and withou t hydronephrosis. In terms of overall survival 4 factors were signific ant: 1) performance status, 2) T stage, 3) absence of hydronephrosis a nd 4) complete response. By multivariate analysis performance status, hydronephrosis and T stage were significant factors for local control, while T stage and complete response were the strongest determinants f or survival. Conclusions: Concurrent cisplatin and radiation therapy i s a potentially curative and conservative treatment for patients with localized muscle invasive bladder cancer who are not candidates for ra dical surgery, particularly those with intravesical stages T2 and T3A tumors.