Nuclear Medicine & Radiation Therapy

Bladder Preservation with Concurrent Radiotherapy and Gemcitabine following Maximal Transurethral Resection for Muscle Invasive Bladder Cancer: Single Institutional Experience

Abstract

Mutahir A. Tunio, Mushabbab Al Asiri, Mohsin Fareed, Shoaib Ahmed, Yasser Bayoumi and Abdullah Amro

Abstract Objectives: For bladder preservation, cisplatinum is widely used radiosensitizer with concurrent chemoradiation (CRT). We aimed to evaluate the safety profile and potential benefit of gemcitabine as a radiosenistizer in bladder preservation.

Patients and methods: During July 2006 to January 2007, consecutive 32 patients with T2-T4N0M0 bladder cancer underwent transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiation with weekly gemcitabine 100 mg/m2 . Conformal radiotherapy was given with a shrinking field technique. Complete response was defined as no visible tumor on cystoscopy and biopsy.

Results: Of total, 26 patients received a median of 7 (3–8) cycles of gemcitabine and median cumulative radiation dose of 65 Gy. Grade 3 hematologic toxicities seen were; neutropenia (3.8%) and thrombocytopenia (7.7%). Grade 3 non-hematologic toxicities were; diarrhea (19.2%), nausea/vomiting (7.7%) and cystitis (15.4%). Complete response was achieved in 18 patients (69.2% [95% CI: 60–89%]). At median follow up of 36 months, four patients had local recurrences (two superficial and two muscle invasive). The overall intact bladder and overall survival rates were 75.1% and 56.3%, respectively. Conclusion: CRT with weekly gemcitabine was found feasible and highly active in the treatment of muscle invasive bladder cancer, as the 3 year intact bladder survival rates were promising.