Neo-adjuvant chemotherapy and radical irradiation for locally advanced bladder cancer--a phase 2 study

Eighteen patients with T3 or T4 bladder cancer were treated with neo-adjuvant chemotherapy and radical irradiation. The tumour response was assessed after two cycles of chemotherapy and two further cycles of chemotherapy were given to patients with responding tumours. Each cycle of chemotherapy consisted of cisplatin (60 mg/m2) as well as methotrexate and vinblastine. After chemotherapy, a complete response (CR) was obtained in four (22%) patients and a partial response in eight (44%) of patients. After irradiation, a complete response was obtained in 12 (67%) patients. Four of the 12 patients who achieved a CR relapsed at a minimum follow-up of 3 years. The 3-year continuously disease-free survival rate (with preserved bladders) is 44%. (95% confidence interval = 21-65%.) Altogether, 11 patients are alive (including three who have undergone salvage cystectomy) for an overall 3-year survival rate which is 61%. This approach to therapy is feasible but the local control rate is unsatisfactory.