Published online Aug 28, 2013. doi: 10.4329/wjr.v5.i8.267
Revised: July 18, 2013
Accepted: August 4, 2013
Published online: August 28, 2013
Processing time: 122 Days and 20.9 Hours
The purpose of this study was to review the magnitude of contribution of chemotherapy (CT) in the local control of muscle invasive bladder carcinoma in the studies where a combined radio-chemotherapy (RCT) was used (how much higher local control rates are obtained with RCT compared to RT alone). Studies on radiotherapy (RT) and combined RCT, neo-adjuvant, concurrent, adjuvant or combinations, reported after 1990 were reviewed. The mean complete response (CR) rates were significantly higher for the RCT studies compared to RT-alone studies: 75.9% vs 64.4% (Wilcoxon rank-sum test, P = 0.001). Eleven of the included RCT studies involved 2-3 cycles of neo-adjuvant CT, in addition to concurrent RCT. The RCT studies included the one-phase type (where a full dose of RCT was given and then assessment of response and cystectomy for non-responders followed) and the two-phase types (where an assessment of response was undertaken after an initial RCT course, followed 6 wk later by a consolidation RCT for those patients with a CR). CR rates between the two subgroups of RCT studies were 79.6% (one phase) vs 71.6% (two-phase) (P = 0.015). The average achievable tumour control rates, with an acceptable rate of side effects have been around 70%, which may represent a plateau. Further increase in CR response rates demands for new chemotherapeutic agents, targeted therapies, or modified fractionation in various combinations. Quantification of RT and CT contribution to local control using radiobiological modelling in trial designs would enhance the potential for both improved outcomes and the estimation of the potential gain.
Core tip: Chemotherapy is adding approximately an extra 10% to local control rates obtained with radiotherapy alone in the treatment of invasive bladder carcinoma. It seems that potential for radiosensitization by chemotherapy may have reached a plateau. The best achievable tumour control rates, with an acceptable rate of side effects are around 70%. Further increase in complete response response rates demands for new combinations, chemotherapeutic agents or modified fractionation.