803P - Selective bladder preservation by tri-modality therapy for muscle invasive bladder carcinoma

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anticancer Agents
Urothelial Cancers
Surgical Oncology
Therapy
Biological Therapy
Radiation Oncology
Presenter Azza Darwish
Authors A. Darwish1, G. Elhussiny1, W. Arafat2
  • 1Clinical Oncology, University of Alexandria, 21521 - Alexandria/EG
  • 2Clinical Oncology, Alexandria International Hospital, 21521 - Alexandria/EG

Abstract

Purpose

To access safety, tolerance, local control and survival of transurethral resection of Bladder tumor (TURB) followed by concomitant cisplatin, paclitaxel and radiation therapy as selective organ preservation in patients with Muscle Invasive bladder. Addionally, Surviving and ERCC1 gene expression analysis and response to treatmentis also studied.

Methods and materials

A total of 63 patients with transional cell carcinoma (TCC), stage T2–T3, No, Mo bladder carcinoma were enrolled in a protocol of TURP followed by one daily radiotherapy (2Gy/ fraction for a total dose of 44 GY) with concomitant cis-platin 15mg/m2/ day,d1-3 weekly and paclitaxel 50mg/m2/day, weekly.

Four weeks later, all patients were evaluated by cytoscopy and biopsy. Patients with complete response proceeded to consolidation Radiotherapy (2Gy/fr for a total 20GY with concomitant cisplatin and paclitaxel, while those with recurrent tumor went on to salavage. Cystectomy. Following consolidation or salvage surgery, all patients went to complete 4 cycles of cisplatin75mg/m2/ day and paclitaxel 175 mg/day every 21 days. RNA extraction from Biopsy before and after treatment was analysed for survivin and ERCC1 gene expression using real time PCR.

Results

Three patients could not tolerate the treatment and discontinued the protocol during the induction phase while the remaining sixty patients complete the induction phase. The complete response after the induction phase was 75%.

Eleven percent of the complete responders developed superficial relapse with a median time of relapse of 16 months, while 8.9% developed invasive relapse with a median time of 18 months. 2-year disease for survival was 61.7%. Distant metastases we detected in 15.8% the patients. 2year overall survival was 77.2%. RNA was succifully extracted from 65% of patient, real time PCR for ERCC1 and survivin was done, interpretation of data will be presented.

Conclusion

Maximal transurethral resection followed by concomitant cis-platin and paclitaxel, as a bladder preservation therapy, can be considered a valid alternative for treating selected patients with localized muscle invasive TCC of the bladder. ERCC1 and survivn might be a predictive model of treatment response.

Disclosure

All authors have declared no conflicts of interest.