Organ-sparing treatment of advanced bladder cancer: paclitaxel as a radiosensitizer

Transurethral resection of bladder tumor (TUR-BT) and radiochemotherapy with cisplatin achieve high rates of bladder preservation and survival figures identical to radical cystectomy in muscle-invasive bladder cancers. The authors have investigated the potential use of paclitaxel in a radiochemotherapy protocol for patients with inoperable bladder carcinomas and mainly contraindications to cisplatin.

Between October 1997 to August 2004, 42 patients (median age 71 years) suffering from muscle-invasive (n=32) or recurrent (n=10) bladder cancers were treated with a paclitaxel-containing radiochemotherapy (paclitaxel 25-35 mg/m(2) twice weekly) after TUR-BT (R0/1/2/x in n=18/4/14/3) or cystectomy with residual tumor (n=3). Five patients received additional cisplatin. Radiation treatment was administered to a total dose of 45-60 Gy.

76.2% completed the planned regimen. Adaptations of treatment were mainly required due to diarrhea. Grade 3/4 toxicities occurred in 15/1 patients. Severe renal toxicities did not occur. 28 patients underwent restaging TUR-BT 6 weeks after radiochemotherapy (complete remission/partial remission/progressive disease: n=24/3/1). Three patients developed a local recurrence and four distant metastases. Seven patients died from tumor, six of other reasons.

Radiochemotherapy with paclitaxel was feasible and this bladder approach needs further investigation to evaluate whether paclitaxel could become a substitute for cisplatin.