Small cell carcinoma of the urinary bladder treated with chemotherapy and radiotherapy: Results in five cases

Small cell carcinoma of the bladder is a rare and highly aggressive tumor. We report our experience with 5 consecutive patients treated with systemic chemotherapy and adjuvant radiotherapy. TNM stages were T2N0M0 (1 patient), T3aN0M0 (3 patients) and T3bN1M0 (1 patient). The chemotherapy protocol wa s the one used with small cell lung cancer patients at our hospital: six cy cles of alternating PE/CAV (PE: cisplatin, etoposide; CAV: cyclophosphamide , doxorubicin, vincristine). Cystoscopy was performed after the third cycle . Four out of 5 patients were free of macroscopic disease. The fifth patien t had persistent lesions and was treated by cystectomy. This patient develo ped a local-regional recurrence 4 months later a nd died shortly afterwards . Four patients completed the planned six cycles. Cystoscopy with bladder b iopsy was then performed on each, and all had complete remission. They were treated with external radiotherapy (45 Gy pelvis, 60 Gy bladder). One pati ent had invasive bladder recurrence 12 months later and cystectomy was perf ormed. At the last follow-up 42 months later, he was alive and well. The ot her 3 patients were alive and free of disease 60, 48 and 27 months after di agnosis, respectively. These results are clearly more favorable than previo us reports. Cystectomy might, therefore, be unnecessary in some patients.