CONCOMITANT RADIOCHEMOTHERAPY IN INVASIVE BLADDER-TUMORS

The treatment of muscle-invasive bladder tumors currently consists of radical cystectomy with lymph node dissection. A combined radio-chemot herapy treatment could allow to preserve a functional bladder without greater risk of relapse. We present a review of 38 available publicati ons found in the international literature concerning this combination treatment Only 9 publications with appropriate analysis were considere d, including 552 evaluable patients, 44% of whom were suitable for rad ical cystectomy. Cisplatin is the most often used drug. The protocols are variable and generally well tolerated The median follow-up time is 36 months. The immediate complete response rates vary between 48 and 92% and the overall survival rate is between 42 and 82%. The survival with bladder preservation is between 38 and 75%, while the disease-fre e survival with bladder preservation is between 33 and 53%. 11% of the initially complete responders had a superficial recurrence and 30% ha d distant metastases. There is no proven advantage of neoadjuvant poly chemotherapy, there is no consensus for the therapeutical protocol, th e follow-up protocol remains to be defined and the function of the pre served bladder has to be studied Only a prospective randomized trial c ould precise the role of this experimental technique compared to surge ry despite the major evident difficulties (ethical and practical) to c onduct such a trial.