Bladder Cancer Clinical Trial
Official title:
Randomised Trial of Selective Bladder Preservation Against Radical Excision (Cystectomy) in Muscle Invasive T2/T3 Transitional Cell Carcinoma of the Bladder - Feasibility Study
RATIONALE: Drugs used in chemotherapy, such as gemcitabine and cisplatin, work in different
ways to stop the growth of tumor cells, either by killing the cells or by stopping them from
dividing. Giving chemotherapy before surgery may make the tumor smaller and reduce the amount
of normal tissue that needs to be removed. Radiation therapy uses high-energy x-rays to kill
tumor cells. It is not yet known whether radiation therapy is more effective than surgery in
treating patients with bladder cancer.
PURPOSE: This randomized phase III trial is studying radiation therapy to see how well it
works compared with surgery in treating patients with bladder cancer who are receiving
chemotherapy.
OBJECTIVES:
Primary
- To determine the feasibility and patient acceptability of radical cystectomy vs
selective bladder preservation (SBP) after neoadjuvant chemotherapy in patients with
muscle-invasive transitional cell carcinoma of the bladder.
- To determine compliance rates of patients with their assigned treatments.
- To determine if bladder preservation is equivalent to radical cystectomy, in terms of
overall survival, in responders to neoadjuvant chemotherapy.
Secondary
- To compare the overall survival of patients receiving SBP vs radical cystectomy.
- To determine the rate of salvage cystectomy in patients undergoing bladder preservation.
- To determine and compare the toxicity of treatment in both arms.
- To determine and compare quality of life of patients treated with these regimens.
- To compare locoregional progression-free and metastasis-free survival of patients
treated with these regimens.
OUTLINE: This is a multicenter study. Patients are stratified according to cancer center and
randomized to 1 of 2 treatment arms. Patients are assessed after completion of 3 courses of
pre-study neoadjuvant chemotherapy. Patients with poor response (≥ pT2, residual pT2,
macroscopic invasive tumor) undergo immediate radical cystectomy (within 6 weeks fo
completing chemotherapy). Patients* with responsive disease (≤ pT1 tumor or macroscopically
normal bladder) proceed to course 4 of chemotherapy (on-study) followed by treatment
according to randomization arm.
NOTE: *Patients with a clear bladder or those who are unsure of their histological results
prior to course 4 also proceed to chemotherapy.
- Course 4 of neoadjuvant chemotherapy: Patients receive gemcitabine hydrochloride IV over
30 minutes on days 1 and 8 and cisplatin IV over 4 hours on day 1.
- Arm I (radical cystectomy): Patients undergo a radical cystectomy, including pelvic
lymphadenectomy, between 4 and 6 weeks after initiating course 4 of chemotherapy.
- Arm II (selective bladder preservation): Patients with no visible residual tumor (cT0 or
pT0) or residual but superficial tumor (pTa, pT1) undergo radiotherapy beginning within
4-6 weeks of day 1 of course 4 and continuing for 6.5 weeks.
Health-related quality of life is assessed periodically.
After completion of study treatment, patients are followed periodically for up to 5 years.
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