Neoadjuvant chemotherapy and bladder preservation for invasive bladder cancer

A total of 16 patients with muscle invasive bladder cancer, clinical stage T2N0M0 (6), T3aN0M0 (7) or T3bN0M0 (3), underwent 1 to 4 cycles of neoadjuvant cisplatin-based chemotherapy followed by either partial cystectomy or transurethral resection. The overall response rate to the chemotherapy was 56% (95% confidence limits 32 to 79%). For the stages T2 and T3a cancer patients the overall response rate was 69%, while all 3 patients with T3b cancer showed incomplete response. Ten (63%) of 16 patients relapsed. Recurrence of superficial bladder cancer was observed in 5 patients with T2G2-3 or T3aG2 tumors, whereas invasive bladder cancer or metastases developed in 5 patients with T3a-3bG3 tumors. Eleven (69%) patients are alive with a functional bladder at a median followup of 48 months+. While bladder preservation may be permitted in selected patients with T2-3a disease, it is inconclusive whether neoadjuvant chemotherapy improves the survival of patients with invasive bladder cancer.