The chemotherapy of urologic cancer

Carter, Stephen K.; Wasserman, Todd H.

doi:10.1002/1097-0142(197508)36:2+<729::aid-cncr2820360818>3.0.co;2-d

Cited by 135 publications

(15 citation statements)

References 53 publications

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“…While it is too early to draw definitive conclu-sions from this study, our results at present are superior to those reported by Jewett (1970), by Cuccia (1969) and by Kuohara et al (1965) for surgery or radiotherapy alone, and are also superior to the results reported by Carter and Wasserman (1975) for surgery combined with radiotherapy.…”

Section: Discussioncontrasting

confidence: 75%

Combined Surgery and Adjuvant Chemotherapy with High Dose Methotrexate and Folinic Acid Rescue (HDMTX-CF) for Infiltrating Tumours of the Bladder

Socquet¹

1982

Journal of Urology

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Of the 44 patients seen during the period January 1 9 7 4 t o March 1 9 7 9 with category T 3 or T 4 bladder cancer, 3 3 were treated by partial or total cystectomy followed by adjuvant chemotherapy with high dose methotrexate and folinic acid rescue (HDMTX-CF), with a survival rate a t 2 years of 9 0 % . Two patients were given palliative treatment with HDMTX-CF alone; one of them is alive and disease-free after 39 months.A study of recent publications on the treatment of infiltrating tumours of the bladder shows that this disease is too frequently treated as a local condition with local treatment, i.e. surgery or radiotherapy or a combination of both. In fact, patients suffering from infiltrating bladder cancer should be considered as having a systemic disease, or at least a disease that has the potential for systemic involvement. It follows that if the therapeutic objective is cure, therapy should contain a systemic element.This hypothesis assumes clinical importance when the results of local treatment alone of infiltrating bladder cancer are considered. In a review of the English language medical literature, Jewett (1970) showed that the results of total cystectomy alone were poor, the 5-year survival rate for patients with category T3 and T4 lesions being 9 and 3% respectively. The 5-year survival rate following radiotherapy as primary treatment was little better, being 19 and 1% for patients with T3 and T4 tumours respectively (Kuohara et al., 1965;Cuccia, 1969). Other reports by Morrison and Deeley (1963, Prout et al. (1970), Van der Werf Messing ( 1 9 7 9 , Miller (1 977), and Ellingwood et al. (1 979), using surgery combined with radiotherapy, have shown improved results but there is clearly considerable scope for improvement and a satisfactory approach to the treatment of infiltrating bladder tumours has yet to be found. In this study which concerns patients with category T3 and T4 lesions we have used adjuvant chemotherapy with high

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Section: Discussioncontrasting

confidence: 75%

Combined Surgery and Adjuvant Chemotherapy with High Dose Methotrexate and Folinic Acid Rescue (HDMTX-CF) for Infiltrating Tumours of the Bladder

Socquet¹

1982

Journal of Urology

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“…We evaluated a combination of 5-FU, mitomycin C and radiotherapy in a phase I dose escalation study using a similar schedule adapted from that used in UKCCCR anal carcinoma study (UKCCCR working party, 1996). 5-Flourouracil is systemically active in bladder cancer (Carter and Wasserman, 1975;Logothetis et al, 1991;Huan et al, 1995). Mitomycin C is of value as a radiosensitiser (UKCCCR working party, 1996).…”

Section: Evidence For Organ Preservationmentioning

confidence: 99%

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

et al. 2004

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We conducted a phase I/II study investigating synchronous chemoradiotherapy with mitomycin C and infusional 5-fluorouracil (5-FU) in muscle invasive bladder cancer. Early dose escalation results were previously published. We report the long-term toxicity and efficacy results with the optimised regimen. Patients with muscle invasive bladder cancer with glomerular filtration rate 425 ml min À1 were eligible. Mitomycin (12 mg m À2 on day 1 only) and infusional 5-FU (500 mg m À2 day À1 ) for 5 days were administered during weeks 1 and 4 of radiotherapy of 55 Gy in 20 fractions. A total of 41 patients were enrolled, median age was 68 years, 33 were male and eight female patients. Out of the 41 patients, 20 (49%) had hydronephrosis at presentation and 25 (62%) had T3b or T4 disease. Four patients experienced Grade III thrombocytopenia and three patients had Grade III neutropenia. There were no episodes of febrile neutropenia. Four patients experienced Grade III diarrhoea and 1 Grade III urgency and dysuria. Six patients did not undergo cystoscopic evaluation due to early metastatic spread although there was no clinical suggestion of bladder failure. In all, out of 35 evaluable patients, 25 (71%) had macroscopic complete response at 3-month cystoscopy, and biopsy confirmed in 24 out of 25. A total of 16 (39%) patients remain alive with a median follow-up of 50.7 (range 23.5 -68.8) months, 14 with a functioning bladder with no reported long-term treatment-related bladder or bowel toxicity. Five out of 41 patients have undergone salvage cystectomy: two for persistent CIS, two T1 and one muscle invasive recurrence. Four patients have received intravesical chemotherapy, of whom two remain alive with a functioning bladder. Overall 12-, 24-and 60-month (m) survival rates were 68, 49 and 36%. Local and distant progression free rates were 82 and 86% at 12-m and 79 and 75% at 24-m. Organ preservation using multimodality therapy is feasible and safe, even in patients with poor renal reserve, and does not compromise salvage therapies. A national phase III trial BC2001 (www.bc2001.org.uk) exploring the effects of synchronous chemoradiotherapy with this regimen is currently recruiting.

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“…It is possible that other agents might fare better. Carter and Wasserman (1975), after reviewing the reports on chemotherapy in bladder cancer, concluded that there were only 3 other agents of proven value : adriamycin, mitomycin C and 5-fluorouracil. We considered that the cardiotoxicity of adriamycin precluded its inclusion in our regime.…”

Section: Years Since Randomisationmentioning

confidence: 77%

Adjuvant Chemotherapy in T3 Carcinoma of the Bladder A Prospective Trial: Preliminary Report

Shearer

Chilvers

Bloom

et al. 1988

British Journal of Urology

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We report the early results of a multi-centre, randomised prospective trial of neoadjuvant and maintenance chemotherapy with methotrexate (MTX) in 376 patients with advanced (T3) carcinoma of the bladder. In patients under 65 years of age, treatment consisted of radical radiotherapy (64 Gy) or, in some centres, pre-operative radiotherapy (44 Gy) and elective cystectomy. All patients over 65 had radical radiotherapy. MTX was administered to 188 patients. There was no increase in toxicity attributable to the MTX. MTX did not significantly increase the proportion of patients whose tumours responded to radiotherapy; 50% (70/141) responded to radiotherapy and 56% (76/136) to MTX radiotherapy. The development of metastases and survival was also similar in both groups (3-year survival: radiotherapy 37.3%, MTX + radiotherapy 38.6%). We report the logistic difficulties of the administration of prolonged courses of maintenance chemotherapy. Further controlled trials of neo-adjuvant chemotherapy in advanced bladder cancer are required, involving more active regimes.

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The chemotherapy of urologic cancer

Cited by 135 publications

References 53 publications

Combined Surgery and Adjuvant Chemotherapy with High Dose Methotrexate and Folinic Acid Rescue (HDMTX-CF) for Infiltrating Tumours of the Bladder

Combined Surgery and Adjuvant Chemotherapy with High Dose Methotrexate and Folinic Acid Rescue (HDMTX-CF) for Infiltrating Tumours of the Bladder

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

Adjuvant Chemotherapy in T3 Carcinoma of the Bladder A Prospective Trial: Preliminary Report

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