A PILOT-STUDY OF CHEMOTHERAPY ALTERNATING WITH TWICE-A-DAY ACCELERATED RADIATION-THERAPY AS AN ALTERNATIVE TO CYSTECTOMY IN MUSCLE INFILTRATING (STAGES T2 AND T3) CANCER OF THE BLADDER - PRELIMINARY-RESULTS

Laboratory studies have suggested that rapidly alternating chemotherap y and accelerated radiation therapy might act synergistically. We eval uated the toxicity and effectiveness of this approach in muscle infilt rating transitional cell carcinoma of the bladder in patients who were poor risks for or who refused cystectomy. We treated 18 men and 3 wom en with stage T2 or T3 transitional cell carcinoma of the bladder by t ransurethral resection, followed by 3 cycles of chemotherapy (during w eeks 1, 4 and 7) rapidly alternating with 3 cycles of twice-a-day radi ation therapy (during weeks 2, 5 and 8). Chemotherapy consisted of met hotrexate, vinblastine, doxorubicin and cisplatin. The total dose of r adiation therapy was 5,400 to 6,000 cGy. during 61/2 weeks and the tot al duration of chemotherapy and radiation therapy was 71/2 weeks. One patient died of hematological toxicity during treatment. With a median followup of 2 years (range 0.5 to 5.5 years) the observed survival ra te was 72% at 2 years and 60% at 3 years. To date, only 1 patient (5%) had recurrence of invasive cancer in the pelvis. Only 3 others (15%) had carcinoma in situ but to date none has required cystectomy. Bladde r function was normal in 15 of 18 evaluable patients (83.5%). This pil ot study suggests that chemotherapy alternating with radiation therapy produced an encouraging survival rate without cystectomy