Neoadjuvant chemotherapy with gemcitabine and carboplatin followed by concurrent chemoradiotherapy in locally advanced carcinoma of urinary bladder

Abstract

4715 Background: In locally advanced carcinoma of urinary bladder radiation therapy, either alone, or in combination with chemotherapy is the treatment of choice for patients whose disease is not amenable to surgery. This study was carried out to evaluate the efficacy and toxicity of Neoadjuvant chemotherapy with Gemcitabine and Carboplatin followed by concurrent chemoradiotherapy in locally advanced carcinoma urinary bladder. Patients and Methods: 22 patients were enrolled. All patients initially received 4 cycles of Gemcitabine and Carboplatin, after which response evaluation was done with CT scanning and ultrasonography. Patients with complete response (CR) and partial response (PR) received 2 more cycles followed by radical radiotherapy with weekly Gemcitabine as radiation sensitizer. Those who had stable disease (SD) or progressive disease (PD) were given concurrent chemoradiotherapy after four cycles. Results: Twenty patients were males and two were females. The median age was 52 years (range 35–70 years). All patients had histopathological subtype of transitional cell carcinoma. Eleven (50%) patients had T3 lesion, 7(31.81%) had T4 and 4(18.18%) cases had T2 lesion. Out of 22, 6(27.27%) patients showed CR, and PR was seen in 9(40.90%) patients. Four (18.18%) patients had SD whereas 3 patients showed progression of the disease. Two cases out of four having stable disease showed regression of tumor after concurrent chemoradiotherapy. No grade III/IV toxicity was seen. Common toxicities observed were Neutrogena, fatigue, loss of appetite and myalgias. Conclusion: Neoadjuvant chemotherapy with gemcitabine-carboplatin followed by concurrent chemoradiotherapy is a well tolerable and effective treatment modality to achieve significant tumor response in locally advanced bladder carcinoma. No significant financial relationships to disclose.