EFFICACY OF NEOADJUVANT GEMCITABINE AND CISPLATIN IN THE MANAGEMENT OF MUSCLE-INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER

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  • Hashimoto Kohei
    Department of Urology, NTT-East Corporation Sapporo Medical Center
  • Shindo Tetsuya
    Department of Urology, NTT-East Corporation Sapporo Medical Center
  • Itoh Naoki
    Department of Urology, NTT-East Corporation Sapporo Medical Center

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Other Title
  • 筋層浸潤性膀胱癌に対するネオアジュバントGC療法の検討
  • キンソウ シンジュンセイ ボウコウ ガン ニ タイスル ネオアジュバント GC リョウホウ ノ ケントウ

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(Objective) We investigated the efficacy of neoadjuvant chemotherapy with gemcitabine and cisplatin (GC) in patients with muscle-invasive bladder cancer. (Method) This was a retrospective analysis of 14 patients who received neoadjuvant GC before radical cystectomy for clinical stage T2-4N0-3M0 bladder cancer. The primary outcome was pT0 rate and no residual muscle-invasion (≤pT1) at cystectomy. (Results) Before chemotherapy, clinical stage T2 was in 8 (57%), T3 in 6 (43%) and N+in 3 (21%). Relative dose intensity was 75% for gemcitabine and 91% for cisplatin. At cystectomy, pT0 was observed in 4 (29%) and ≤pT1 in 10 (71%). Regarding lymph node metastasis, 2 with N1 had pN0 and pN1, respectively, and 1 with N3 did pN1. Grade 3 or 4 anemia, thrombocytopenia, neutropenia, and febrile neutropenia were observed in 3 (21%), 9 (64%), 9 (64%) and 1 (7%), respectively. Three patients died of bladder cancer at median follow-up of 33 months. The 4-year overall survival rate in patients with pT0 was 100% compared to 47% in those with residual diseases (P=0.153). (Conclusions) We showed the proportion of pT0 at cystectomy to predict the effect of neoadjuvant GC. The results suggest that neoadjuvant GC is feasible for patients with muscle-invasive bladder cancer.

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