Characterization and Outcomes of Small Cell Carcinoma of the Bladder Using the Surveillance, Epidemiology, and End Results Database

Abstract

Small cell carcinoma of the bladder is a rare but aggressive malignancy with poor OS. For those who present without widespread metastatic disease, treatment with either cystectomy or radiation appears to improve survival. Further prospective studies are needed to determine the best approach for treatment of these patients.

Nonurothelial Bladder Cancer and Rare Variant Histologies

“…63 For patients unable to undergo cystectomy, combined chemoradiotherapy has been proposed as an alternative with fairly equivalent outcomes based on small retrospective cohorts with short follow-up. 64,65 Because of the need for systemic treatment for small cell carcinoma of the bladder, intravesical therapy for NMI small disease conceptually is inappropriate. Although this Variant Histology Bladder Cancer has never been officially reported, we advocate primary chemotherapy with a small cell-specific regimen (ie, cisplatin with etoposide) followed by surgical extirpation as the mainstay of treatment for any degree of small cell carcinoma at any stage.…”

Management of small cell carcinoma of the bladder: Consensus guidelines from the Canadian Association of Genitourinary Medical Oncologists (CAGMO)

“…Literature review identified 43 retrospective series and case reports, the majority being quite small (range: 1-663 patients). 68 The only prospective studies were a non-randomized phase II study 31 and a single-centre study of 25 cases treated in a fashion analogous to SCLC. 28 The National Cancer Care Network (NCCN) 69 was the only identified guideline which included SCCB.…”

“…In the previously described SEER data, 68 patients with metastatic disease at diagnosis had a median survival of 5 months (95% CI, 3.7-6.3). In addition, Ismaili and colleagues reported that patients with recurrent and metastatic SCCB had a median overall survival of 7.6 months.…”

“…However, TURBT is inadequate for local control of SCCB due to the aggressive nature of this disease. In the Surveillance, Epidemiology, and End Results (SEER) data, 68 patients who had only biopsy or TURBT, had a median overall survival of only 11 months (95% CI, 9.3-12.7). The remaining studies in our review of LD SCCB used TURBT as a diagnostic/ therapeutic procedure that preceded definitive local therapy as done in UCB.…”

“…Both treatments improved survival on multivariate analysis, with hazard ratios of 0.53 for cystectomy and 0.66 for radiation. 68 During and after treatment, appropriate follow-up is important to assess for response and potential recurrence. In UCB, patients who receive neoadjuvant chemotherapy are usually reassessed with CT scans and cystoscopy after 2 cycles of chemotherapy.…”