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Post-chemotherapy surgery in patients with unresectable or regionally metastatic bladder cancer
H W Herr1, S M Donat, D F Bajorin
1Department of Urology and Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, Weill Medical College, Cornell University, New York, New York, USA.
Purpose:
We update our experience with post-chemotherapy surgery in patients with unresectable or lymph node positive bladder cancer.
Methods:
Of 207 patients with unresectable or regionally metastatic bladder cancer 80 (39%) underwent post-chemotherapy surgery after treatment with a cisplatin based chemotherapy regimen. We assessed the impact of surgery on achieving a complete response to chemotherapy and on relapse-free survival.
Results:
No viable cancer was present at post-chemotherapy surgery in 24 of the 80 cases (30%), pathologically confirming a complete response to chemotherapy. Of the 24 patients 14 (58%) survived 9 months to 5 years. Residual viable cancer was completely resected in 49 patients (61%), resulting in a complete response to chemotherapy plus surgery, and 20 (41%) survived. Post-chemotherapy surgery did not benefit those who failed to achieve a major complete or partial response to chemotherapy. Only 1 of the 12 patients (8%) who refused surgery remains alive.
Conclusions:
Post-chemotherapy surgical resection of residual cancer may result in disease-free survival in some patients who would otherwise die of disease. Optimal candidates include those in whom the pre-chemotherapy sites of disease are restricted to the bladder and pelvis or regional lymph nodes, and who have a major response to chemotherapy.