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Locally Advanced Small-Cell Bladder Cancer Responds to Aggressive Chemo/Radiation Combo

by Dr. C.H. Weaver M.D. (02/2018)

Small-cell cancer of the urinary bladder is a rare cancer for which more effective treatments are being developed. Because this cancer behaves similarly to small-cell cancer of the lung, researchers have been studying the effects that treatments for lung cancer might have if used against small-cell bladder cancer. Recently, researchers in Barcelona found that persons with locally advanced (stage II-III) disease responded favorably to a combination of intensive chemotherapy and radiation therapy.

Cancer of the bladder is characterized by the presence of cancer cells in the bladder, the organ that is located in the lower abdomen and that serves to store urine. Treatment options, which depend on the stage of the cancer (extent of disease at diagnosis) and a number of other factors, may include surgery, radiation therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. Emerging evidence suggests that a type of bladder cancer called small-cell cancer of the bladder, also referred to as neuroendocrine cancer of the bladder, may behave much like small-cell cancer of the lung. For this reason, researchers have been studying the aggressive use of chemotherapy and radiation combinations that are used to treat persons with small-cell lung cancer as potential treatments against small-cell bladder cancer.

Spanish researchers treated 5 persons with small-cell bladder cancer with a regimen that was developed for persons with small-cell lung cancer. The patients had locally advanced disease (stage II-III), meaning that the cancer in the bladder had spread to the inside of the muscle lining in the bladder and, in some, through the muscle wall of the bladder to nearby tissue and reproductive organs. The patients received 3 cycles of chemotherapy with cisplatin and etoposide, alternated with 3 cycles of cyclophosphamide, doxorubicin, and vincristine. All patients also received radiation therapy. Four of the 5 patients had a complete remission, while the fifth had to undergo further treatment with a surgery, called a radical cystectomy, to remove the bladder, surrounding tissue, and nearby reproductive organs. One of the patients had a recurrence (return) of the cancer and then had to undergo further treatment with a surgery, called a cystectomy, to remove the bladder. One patient died after a recurrence of the cancer. Overall, 27 to 60 months after diagnosis, 4 of the 5 patients remain alive and free of disease.

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The researchers concluded that this aggressive treatment regimen developed to treat small-cell lung cancer appears to be effective against small-cell bladder cancer. Persons with small-cell bladder cancer may wish to talk with their doctor about the risks and benefits of receiving this intensive chemotherapy/radiation therapy combination or of participating in a clinical trial in which other promising new treatments are being studied. Sources of information on ongoing clinical trials that can be discussed with a doctor include a comprehensive, easy-to-use service provided by the National Cancer Institute ( . (European Urology, Vol 35, No 4, pp 323-326, 1999)