ABSTRACT
AIM: The aim of our study was to compare the two standard treatment approaches in muscle invasive carcinoma of urinary bladder--radical cystectomy and chemo radiation. MATERIALS AND METHODS: Transitional cell carcinoma (TCC) of bladder of stages, T2 to T4, N0/N1/N2 and M0 were included in the study. Patients were allotted to two arms of the study. Arm A consisted of radical cystectomy. Adjuvant CMV chemotherapy was given for T3/T4 or Node positive disease only. Arm B received 2 cycles of neoadjuvant CMV chemo therapy followed by concurrent chemo radiation. RESULTS: Forty-four patients were recruited into the study. Thirty patients in the surgical arm and 13 patients in the chemo radiation arm. The actuarial two-year survival rate in surgical arm is 56% while in chemo radiation arm it is 54%. There was no statistically significant difference in disease-free survival also between the two groups. CONCLUSION: Chemo radiation yielded equivalent survival results with radical cystectomy. So it is worth giving preference to chemo radiation that will give a better quality of life for the patient.
Subject(s)
Adult , Aged , Aged, 80 and over , Carcinoma, Transitional Cell/radiotherapy , Humans , Male , Middle Aged , Muscle Neoplasms/radiotherapy , Neoplasm Invasiveness , Treatment Outcome , Urinary Bladder Neoplasms/pathologyABSTRACT
This study which was conducted from January 1995 to December 1999 included two groups of patients, the young group [n 19] <50 Y [Range 30-50Y and Median 43Y] and the old group [n 18] >50Y [Range 52-70Y and Median 62Y]. All patients had pathologically documented muscle invasive transitional cell carcinoma of the bladder and all had a Karnofsky performance status of >70. Treatment protocol included cytoreductive transurethral resection of the tumor, 2 cycles of MVAC chemotherapy [methotrexate, vinblastine, doxorubicin and cisplatin] and radiotherapy [45 grays [GY] on pelvic volume with concurrent cisplatin [20mg/m[2] on days 1-5]. Response was determined by cytoscopic examination with tumor site biopsy and urine cytology. If there was a complete response, radiotherapy continued to a total dose of 65GY, if there was no complete response, cystectomy was performed. Of the young group [n 19] 12 patients 63% had complete response, 5 [26%] had partial response and 2 [11%] had no response. In the old group [n 18], 9 patients [50%] had complete response, 6 [33%] had partial response and 3 [17%] had no response. A significant difference in response to treatment was detected between T2 and T3a and between Bilharzial and non Bilharzial groups of patients P [0.037] and P [0.002] respectively. Overall survival for the young group was 50%, 39%, 30% in the 2[nd], 3[rd] and 5[th] years of follow up respectively, while in the old group it was 45%, 35%, and 30% for the 2[nd], 3[rd], 5[th] years of follow up respectively. Severe toxicity was uncommon. The most frequent toxicities being emesis and cystitis in both groups. The difference between both groups regarding toxicity, tolerability and response to treatment was not statistically significant. This protocol of treatment can be used for both young and elderly patients of muscle invading transitional cell carcinoma of the bladder especially in low stage non Bilharzial cancer despite a few well tolerated short term complications
Subject(s)
Humans , Male , Female , Carcinoma, Transitional Cell/radiotherapy , Chemotherapy, Adjuvant , Follow-Up Studies , Treatment Outcome , Survival RateABSTRACT
Em 20 pacientes com CCTB localmente infiltrativo realizou-se pesquisa do conteúdo do DNA em amostras de tumores obtidos por ressecçäo ou biópsia endoscópica, para avaliar a possibilidade de previsäo de resposta àquimioterapia por M-VAC. Histologicamente, 30 por cento dos tumores eram diferenciados e 70 por cento pouco diferenciados. Os tumores eram diplóides em 5 por cento, tetraplóides em 5 por cento e aneuplóide em 90 por cento. Observou-se resposta completa à quimioterapia em 55 por cento e resposta negativa em 45 por cento dos casos. A avaliaçäo da haploidia do DNA näo contribuiu para a detecçäo de neoplasias responsivas ao esquema M-VAC