Favourable outcomes of patients with clinical stage T3N0M0 bladder cancer treated with induction low-dose chemo-radiotherapy plus partial or radical cystectomy vs immediate radical cystectomy: a single-institutional retrospective comparative study

OBJECTIVES To address the role of neoadjuvant concurrent chemo-radiotherapy (CRT) in muscle-invasive bladder cancer, by comparing retrospectively the oncological outcomes between a low-dose CRT (LCRT) plus partial cystectomy (PC) or radical cystectomy (RC) protocol and an immediate RC protocol. PATIENTS AND METHODS From 1997 to 2007, 119 patients with clinical stage T2-4aN0M0 bladder cancer received LCRT consisting of RT of 40 Gy in 4 weeks concurrently with two cycles of chemotherapy with cisplatin (20 mg/day for 5 days) during the first and fourth week of RT. Subsequently, 24 (20%) and 65 patients (55%) had PC and RC, respectively, while 30 (25%) had no curative surgery; the median follow-up was 36 months. From 1983 to 1997, 73 patients had an immediate RC; 29 (41%) received cisplatin-based adjuvant chemotherapy, and the median follow-up was 46 months. Oncological outcomes were compared retrospectively between these groups. RESULTS The cancer-specific survival (CSS) rate at 5 years was 75% and 61% for the LCRT protocol and immediate RC protocol, respectively (P = 0.11). In patients with clinical stage T3N0M0 the LCRT protocol gave significantly better survival rates than the immediate RC protocol, with 5-year CSS rates of 62% vs 27% (P = 0.006), while being comparable in those with clinical stage T2N0M0 disease (89% vs 88%, P = 0.84). In patients with clinical stage T3N0M0 the LCRT protocol provided a lower 5-year recurrence rate at distant sites than the immediate RC protocol (31% vs 62%, P = 0.09). CONCLUSIONS The LCRT plus PC or RC protocol gave significantly better survival rates than the historical, immediate RC protocol in patients with clinical stage T3N0M0 bladder cancer, suggesting that neoadjuvant CRT possibly has survival benefits for such patients.