Researchers from Italy have reported that chemotherapy for patients with advanced bladder cancer allows many of them to avoid cystectomy, surgical removal of their bladder.

According to Cora Sternberg, MD, and her associates writing in the journal Cancer (Vol. 97, No.7: 1644-1652), more than half of the patients studied were able to keep their bladder.

Bladder cancer is a fairly common disease. The ACS predicts there will be some 57,400 new cases in the U.S. in 2003, and 12,500 deaths. Most patients are men. The major risk factor for this disease is smoking.

Most of the time, the cancer begins as a superficial tumor in the bladder. The usual warning sign is blood in the urine. These tumors can usually be removed locally with a cystoscope – a device that permits the surgeon to look into the bladder and operate. Often surgeons will treat patients with repeated cystoscopies and transurethral resections (TUR) of their tumors. In TUR, the doctor removes the bladder tumors using instruments passed through the cystoscope.

Many times the tumor is too large for this procedure and part or all of the bladder must be removed. Total bladder removal creates major problems for patients. Their urine must be diverted to a bag they wear or into a surgically created pouch of intestine that they periodically empty.

But Sternberg and her colleagues were able to avoid this outcome in nearly two-thirds of their patients whose tumors were too large for a TUR. They treated 104 patients with a combination of four different chemotherapy drugs: methotrexate, doxorubicin, vinblastine and cisplatin.

When the researchers looked into the bladder of 94 of these patients after chemotherapy, they found that 78 of them, or 83%, had major shrinkage of their tumors. The researchers identified 65 patients who did not need radical cystectomy (removal of the entire bladder). Most of these had superficial tumors remaining that could be easily removed through a cystoscope. A few of them needed to have a part of their bladder removed.

Bladder cancer is often a disease of the elderly. In this study, 27 patients were over the age of 70. But they tolerated the chemotherapy treatment as well as the rest of the group.

The Italian researchers found that avoiding surgery did not endanger their patients’ chances for survival. Because these patients had large tumors, the cancer often spread to other organs and killed them. But their death rate was no greater than patients in other studies who underwent cystectomy, and they hadn’t sacrificed their bladders. However, in some patients the tumor grew back in the bladder and they eventually needed cystectomy.

Sternberg and her colleagues concluded: “In carefully chosen patients who respond to neoadjuvant (before surgery) chemotherapy, bladder preservation may be achievable without compromising survival.” They add that this applies to elderly patients as well.