2. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
3. Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt.
4. Department of Radiology Faculty of Medicine, Assiut University, Egypt.
5. Department of Radiotherapy, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
Background: There is a debate regarding the optimal chemotherapeutic regimens that can be used concurrently with radiotherapy (Rth) in muscle invasive bladder cancer (MIBC). Taxanes started to be widely used with evidence of response rates improvement when compared to cisplatin. Our aims were to evaluate the tumor response, treatment toxicity, and disease outcome in MIBC patients who treated with concurrent chemo-radiotherapy (CCRTh) either with paclitaxel and cisplatin or cisplatin alone.
Methods: Between July 2007 and December 2010, sixty T2-4a N0 M0 bladder cancer patients were enrolled, of whom 55 were eligible for analysis. We randomized our patients into two groups; group I received CCRTh with weekly cisplatin (n=25) and group II received CCRTH with weekly paclitaxel and cisplatin (n=30). Kaplan-Meier curve used to estimate overall survival (OS) and recurrence free survival (RFS) with log rank test used to assess the significant difference between patients' subgroups.
Results: A durable complete response (CR) was achieved in 80% and 86.7% in groupI and II respectively. The 2-year OS and recurrence free survival (RFS) were 76% and 61% for group I, and 85.6% and 67.2% for group II, respectively. Multivariate analysis showed that tumor stage was the only survival predictor (P<0.0001). In both groups, the majority of acute and late toxicities were grade 2 with no treatment-related mortality.
Conclusions: Achieving high initial durable CR rates, with acceptable toxicity in both groups; showed that addition of paclitaxel to cisplatin did not significantly add benefit to the treatment outcome.
Keywords: Bladder cancer, paciltaxel, cisplatin, bladder preservation, concurrent chemoradiotherapy