Reinhard Kühn

Combined-Modality Treatment and Selective Organ Preservation in Invasive Bladder Cancer: Long-Term Results

PURPOSE To evaluate our long-term experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival. PATIENTS AND METHODS Between 1982 and 2000, 415 patients with bladder cancer (high-risk T1, n = 89; T2 to T4, n = 326) were treated with radiotherapy (RT; n = 126) or radiochemotherapy (RCT; n = 289) after transurethral resection (TUR) of the tumor. Six weeks after RT/RCT, response was evaluated by restaging-TUR. In case of complete response (CR), patients were observed at regular intervals. In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended. Median follow-up was 60 months (range, 6 to 199 months). RESULTS CR was achieved in 72% of patients. Local control after CR without muscle-invasive relapse was maintained in 64% of patients at 10 years. Distant metastases were diagnosed in 98 patients with an actuarial rate of 35% at 10 years. Ten-year disease-specific survival was 42%, and more than 80% of survivors preserved their bladder. Early tumor stage and a complete TUR were the most important factors predicting CR and survival. RCT was more effective than RT alone in terms of CR and survival. Salvage cystectomy for local failure was associated with a 45% disease-specific survival rate at 10 years. Cystectomy because of a contracted bladder was restricted to 2% of patients. CONCLUSION TUR with RCT is a reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage and unifocal tumors, in whom a complete TUR is accomplished.

Apoptosis, p53, bcl-2, and Ki-67 in invasive bladder carcinoma: possible predictors for response to radiochemotherapy and successful bladder preservation☆

PURPOSE Several groups have reported the value of bladder preservation by a combined treatment protocol, including transurethral resection (TUR-B) and radiochemotherapy (RCT). As more experience is acquired with organ-sparing treatment, patient selection should be optimized. The purpose of this study was to investigate the role of several biologic markers that may predict response to RCT in muscle-invasive bladder carcinoma. METHODS AND MATERIALS The apoptotic index (AI), Ki-67, p53, and bcl-2 were evaluated by immunohistochemistry on pretreatment biopsies from 70 patients treated for invasive bladder cancer by TUR-B and RCT. Expression of each marker was correlated with initial response, local control, and cancer-specific survival with preserved bladder. An exploratory multivariate analysis was also performed that included clinical and immunohistochemical variables. RESULTS A high AI (> median = 1.6%) and a high Ki-67 index (> median = 8.8%), but not the p53- and bcl-2 expression, were significantly related to initial complete response (CR) and local control with preserved bladder after 5 years. When the AI and Ki-67 expression were considered simultaneously, the association with initial CR (p < 0. 001), local control (p = 0.0002), and cancer-specific survival with preserved bladder (p = 0.008) was highly significant. In an exploratory multivariate analysis (final model), only AI, Ki-67, and the combined AI/Ki-67 variable retained significance for local control with preserved bladder at 5 years. CONCLUSION Patients with a high spontaneous AI and a high pretreatment Ki-67 index should be considered preferentially for treatment with RCT, whereas tumors with low proliferation and low levels of apoptosis are less likely to respond to RCT.

Organ preservation in patients with invasive bladder cancer: initial results of an intensified protocol of transurethral surgery and radiation therapy plus concurrent cisplatin and 5-fluorouracil.

PURPOSE To assess safety, tolerance, and disease control of transurethral resection of the bladder tumor (TURB) plus concurrent cisplatin, 5-fluorouracil (5-FU), and radiation therapy (RT) with selective organ preservation in patients with bladder cancer. PATIENTS AND METHODS Forty-five patients with muscle-invading or high-risk T1 (G3, associated carcinoma in situ, multifocality, >5 cm) bladder cancer were entered into a protocol of TURB followed by concurrent cisplatin (20 mg/m(2)/day, 20-min infusion) and 5-FU (600 mg/m(2)/day, 120-hour continuous infusion), administered on Day 1-5 and 29-33 of RT (single dose 1.8 Gy, total dose to the bladder 54-59.4 Gy). Response was evaluated by restaging TURB 6 weeks later. In case of invasive residual or recurrent tumor, salvage cystectomy was recommended. Median follow-up was 35 months (range: 8-80 months). RESULTS Thirty-nine patients (87%) had no detectable tumor at restaging TURB; 29 patients (64%) have been continuously free of tumor in their bladders. A superficial relapse occurred in 4 patients, a muscle-invasive relapse in 6 patients. Overall survival and survival with preserved bladder was 67% and 54%, respectively, at 5 years. Hematologic Grade 3/4 toxicity occurred in 10%/4%; Grade 3 diarrhea occurred in 9%. Thirty-four patients (76%) completed the protocol as scheduled or with only minor deviations. One patient required salvage cystectomy because of a shrinking bladder. CONCLUSION This protocol of concurrent cisplatin/5-FU and RT has been associated with acceptable toxicity. The complete response rate of 87% and the 5-year survival with intact bladder of 54% are encouraging and compare favorably with our historical control series using RT with carboplatin and cisplatin alone.

In vitro study concerning the efficiency of the frequency-doubled double-pulse Neodymium:YAG laser (FREDDY) for lithotripsy of calculi in the urinary tract

In a preclinical study we have tested both in vitro and in vivo, a new type of pulsed solid‐state laser system that has not been applied in urology so far and has been developed for optimized intracorporal lithotripsy of biliary, salivary, and urinary calculi.

Organ-Sparing Treatment in Muscle-Invasive Bladder Cancer

Background and Purpose:Organ-sparing treatment of bladder cancer by a trimodality approach is feasible and effective. In this study, the results of a series of patients are reported, who were, in the majority, not suitable for major surgery.Patients and Methods:In the period from June 1995 through December 2003, 68 patients (64 males, four females) with urothelial bladder cancer were treated with curative intent. The median age was 68 years (range 42–82 years). Clinical T-category was 32× T2, 20× T3, and 16× T4. Transurethral resection was performed in all cases, and a complete TUR-BT (transurethral resection of bladder tumor) was attempted, if possible. Radiotherapy was administered in conventional fractionation (five fractions of 1.8 Gy per week) up to 50.4 Gy to bladder, and regional nodes and the whole bladder received a boost up to 54–59.4 Gy. 34 patients received concurrent cisplatin-based chemotherapy (25 mg/m2 on days 1–5 and 29–33), and patients with impaired renal function were either treated with irradiation alone (n = 7) or received paclitaxel as alternative to cisplatin in a phase II protocol or on an individual decision (n = 27). The median follow-up was 34 months (range 2–104 months).Results:A histologically confirmed complete remission (CR) on restaging cystoscopy was observed in 40/46 patients (87%) who underwent restaging cystoscopy. CR rates were not significantly correlated to T-category (CR: 24/32 T2, 9/19 T3, and 9/16 T4 tumors) or clinical nodal status. Patients with non-radical resection and macroscopic residual tumor (R2 resection) achieved a CR in only 39% (12/31); this figure was significantly lower as compared to patients with radical R0 TUR-BT (CR: 15/16, 94%, p = 0.013) Furthermore, age and preexisting anemia had no impact on response. The overall survival of the whole group was 45% after 5 years, and survival according to clinical T-category was 62% for T2, 43% for T3, and 19% for T4 (p = 0.015). In eleven patients, local disease progression or relapse was observed. So far, only one salvage cystectomy has been performed, due to contraindications to surgery in the majority of patients.Conclusion:The data obtained in this study confirm the high efficacy of TUR and radiochemotherapy for locally advanced bladder cancer.Hintergrund und Ziel:Die organerhaltende Behandlung des lokal fortgeschrittenen Harnblasenkarzinoms hat sich in prospektiven Studien als effektive Maßnahme erwiesen. In dieser Studie werden retrospektive Daten der eigenen Klinik an einem ungünstig selektionierten Kollektiv primär nicht zystektomiefähiger Patienten vorgestellt.Patienten und Methodik:Von Juni 1995 bis Dezember 2003 wurden an der eigenen Klinik 68 Patienten (64 Männer, vier Frauen) mit Urothelkarzinomen der Harnblase in kurativer Intention mit einer Radiotherapie oder Radiochemotherapie behandelt. Der weit überwiegende Teil der Patienten wurde bei lokaler oder funktioneller Inoperabilität zur Strahlentherapie überwiesen. Das mittlere Alter betrug 68 Jahre (Spanne 42–82 Jahre). Die klinische T-Kategorie war 32× T2, 20× T3 und 16× T4. Alle Patienten hatten eine möglichst komplette transurethrale Resektion (TUR). Die Radiotherapie erfolgte in konventioneller Fraktionierung (fünfmal wöchentlich 1,8 Gy) bis zu einer Gesamtdosis von 50,4 Gy an Blase und Lymphknoten; die ganze Blase wurde bis 54 Gy (R0-TUR) bzw. 59,4 Gy (R1–2-TUR) aufgesättigt. 34 Patienten erhielten eine simultane Chemotherapie mit Cisplatin (25 mg/m2 an den Tagen 1–5 und 29–33), und Patienten mit eingeschränkter Nierenfunktion erhielten entweder eine alleinige Strahlentherapie (n = 7) oder wurden im Rahmen eines Phase-II-Protokolls mit Paclitaxel als Ersatz für Cisplatin behandelt (n = 27). Die mediane Nachbeobachtungszeit betrug 34 Monate (Spanne 2–104 Monate).Ergebnisse:Von den 46 zystoskopisch und bioptisch nachkontrollierten Patienten erreichten 40 (87%) eine komplette Remission (CR). Die klinischen CR-Raten waren unabhängig von der initialen T-Kategorie (CR: 24/32 T2-, 9/19 T3- und 9/16 T4-Tumoren) und dem klinischen Nodalstatus. Patienten mit nicht-radikaler TUR und makroskopischem Resttumor (R2-TUR) erreichten in 39% eine CR (signifikant verschieden von Patienten mit R0-TUR). Alter und prätherapeutische Anämie hatten keine Einfluss auf Remissionsrate und Überleben. Die Überlebensrate aller Patienten lag bei 45% nach 5 Jahren, und die Überlebensraten in Abhängigkeit von der T-Kategorie betrugen 62% für T2, 43% für T3 und 19% für T4 (p = 0,015). Bei elf Patienten trat eine lokale Tumorprogression oder ein Rezidiv auf. Bedingt durch die negative Selektion mit primär überwiegend inoperablen Patienten wurde bis jetzt nur bei einem Patienten eine Salvage-Zystektomie durchgeführt.Schlussfolgerung:Die Daten dieser Studie bestätigen die Effektivität der Radiochemotherapie für fortgeschrittene Harnblasenkarzinome selbst bei eher ungünstiger Patientenselektion.

Quadrimodal treatment of high-risk T1 and T2 bladder cancer: Transurethral tumor resection followed by concurrent radiochemotherapy and regional deep hyperthermia

BACKGROUND AND PURPOSE To assess the safety and effectiveness of treating high-risk T1 and T2 bladder cancer with transurethral resection (TUR-BT) followed by radiochemotherapy (RCT) combined with regional deep hyperthermia (RHT). MATERIAL AND METHODS Between 2003 and 2007, 45 patients were enrolled. After TUR-BT patients received radiotherapy (RT) of the bladder and regional lymph nodes with 50.4 Gy, and a boost to the bladder of 5.4-9 Gy. RCT was applied to 43/45 patients. RHT was administered once weekly. Response was re-evaluated 6 weeks after RT by restaging-TUR. Toxicity was graded with the CTCAE, version 3.0. QoL was evaluated by a dedicated questionnaire. RESULTS The median follow-up was 34 months (range 12-60). The median number of hyperthermia treatments was 5 (range 1-7). Acute toxicity grades 3 and 4 occurred in 20% (9/45) and 9% (4/45), respectively. Late toxicity grades 3/4 were seen in 24% (11/45). Complete response rate was 96% (43/45). Local recurrence-free survival was 85%, overall survival was 80%, disease-specific survival was 88%, metastasis-free survival was 89%, and the bladder-preserving rate was 96% (43/45) at 3 years. Eighty percent (24/30) were at least mostly satisfied with their bladder function. CONCLUSIONS The quadrimodal treatment was feasible and well tolerated. Local control and bladder-preserving rates were encouraging.

Radiotherapy is an effective treatment for high-risk T1-bladder cancer

Purpose: Current treatment options for high-risk superficial T1-bladder cancer (Grade 3, associated Tis, multifocality, tumor diameter > 5 cm or multiple recurrences) include early cystectomy or the goal of organ preservation by adjuvant intravesical therapy after transurethral resection (TURB). We have evaluated the efficacy of adjuvant radiotherapy or radiochemotherapy on local control, bladder preservation, recurrence rate and long-term survival after TURB of high-risk T1-bladder cancer. Patients and Methods: From May 1982 to May 1999, a total of 74 patients with T1-bladder cancer were treated by either radiotherapy (n = 17) or concomitant radiochemotherapy (n = 57) after TURB. Radiotherapy was initiated 4 to 8 weeks after TURB; a median dose of 54 (range: 45 to 60) Gy was applied to the bladder with daily fractions of 1.8 to 2.0 Gy. Since 1985 chemotherapy has been given in the 1st and 5th week of radiotherapy and consisted of cisplatin (25 mg/m2/d) in 33 patients, carboplatin (65 mg/m2/d) was administered in 14 patients with decreased creatine clearance (< 50 ml/min). Since 1993 a combination of cisplatin (20 mg/m2/d) and 5-fluorouracil (600 mg/m2/d) was applied to 10 patients. Salvage cystectomy was recommended for patients with refractory disease or invasive recurrences. At the time of analysis, the median follow-up for surviving patients was 57 (range: 3 to 174) months. Results: After radiotherapy/radiochemotherapy, a complete remission at restaging TURB was achieved in 62 patients (83.7%), 35 of whom (47% with regard to the total cohort of the 74 treated patients) have been continuously free of tumor, 11 patients (18%) experienced a superficial relapse and 16 patients (26%) showed tumor progression after initial complete response. Overall-survival was 72% at 5 years and 50% at 10 years with 77% of the surviving patients maintaining their own bladder at 5 years. Negative prognostic factors for cancer-specific were non-complete (R1/2) initial TURB (p = 0.12) and recurrent disease (p = 0.07); combined radiochemotherapy was more effective than radiotherapy alone (p = 0.1). Conclusion: Adjuvant radiotherapy/radiochemotherapy offers an additional option in high-risk superficial bladder cancer with a high chance of cure and bladder preservation. The ultimate value of radiotherapy in comparison with other treatment options should be determined in randomized trials.Hintergrund: Die gegenwärtige Behandlungsoptionen beim oberflächlichen T1-Blasenkarzinom mit hohem Rezidivrisiko (G3, assoziiertes Tis, Multifokalität, Größe > 5 cm, multiple Rezidive) umfassen die sofortige Zystektomie oder die transurethrale Resektion (TURB) mit adjuvanter intravesikaler Therapie zum Zweck des Organerhalts. Wir haben die Wirksamkeit einer adjuvanten Radio- oder Radiochemotherapie bezüglich lokaler Kontrolle, Blasenerhalt, Rezidivrate und Langzeitüberleben bei T1-Blasenkarzinom mit hohem Risikoprofil untersucht. Patienten und Methoden: Von Mai 1982 bis Mai 1999 wurden 74 Patienten mit Hochrisiko-T1-Blasenkarzinom nach TURB bestrahlt (n = 17) oder radiochemotherapiert (n = 57). Die Radiotherapie begann vier bis acht Wochen nach TURB; im Median wurden 54 Gy (Spanne: 45 bis 60 Gy) mit einer Einzeldosis von 1,8 bis 2,0 Gy auf die Blase verabreicht. Seit 1985 erfolgte eine simultane Chemotherapie in der ersten und fünften Radiotherapiewoche mit Cisplatin (25 mg/m2/Tag) bei 33 Patienten, 14 Patienten mit reduzierter Kreatininclearance (< 50 ml/min) erhielten Carboplatin (65 mg/m2/Tag). Seit 1993 wurde eine Kombination von Cisplatin (20 mg/m2/Tag) und 5-Fluorouracil (600 mg/m2/Tag) bei 10 Patienten eingesetzt. Die Salvage-Zystektomie wurde für Patienten mit refraktärem Karzinom oder invasivem Rezidiv empfohlen. Zum Auswertezeitpunkt war die mediane Nachbeobachtungszeit für die überlebenden Patienten 57 Monate (Spanne: drei bis 174 Monate). Ergebnisse: Eine komplette Remission bei der Restaging-TURB nach Radiotherapie/Radiochemotherapie wurde bei 62 Patienten (83,7%) erreicht, von denen 35 (47% bezogen auf die Gesamtzahl der 74 behandelten Patienten) im weiteren Verlauf tumorfrei blieben; elf Patienten (18%) erlitten ein oberflächliches Rezidiv, 16 Patienten (26%) zeigten eine Tumorprogression nach initialer kompletter Remission. Das Gesamtüberleben nach fünf Jahren betrug 72%, nach zehn Jahren 50%; 77% der nach fünf Jahren überlebenden Patienten konnten ihre Blase erhalten. Prognostisch ungünstige Faktoren bezüglich des krankheitsspezifischen Überlebens waren eine nicht radikale (R1/2) initiale TURB (p = 0,12) und eine Behandlung nach multiplen Rezidiven (p = 0,07). Die kombinierte Radiochemotherapie war effektiver als die alleinige Bestrahlung (p = 0,1). Schlussfolgerung: Die adjuvante Radiotherapie/Radiochemotherapie ist eine alternative Behandlungsoption bei oberflächlichen Hochrisikoblasenkarzinomen mit hoher Heilungsrate und Blasenerhalt. Der Stellenwert der Radiotherapie im Vergleich zu anderen Behandlungsmethoden sollte in randomisierten Studien überprüft werden.

Radiotherapy alone or radiochemotherapy with platin derivatives following transurethral resection of the bladder. Organ preservation and survival after treatment of bladder cancer.

PurposeMultivariate analysis of prognostic factors influencing survival and bladder preservation after radiochemotherapy for bladder cancer following transurethral resection of the bladder (TURB)Patients and MethodsAt the University Hospital of Erlangen 333 patients with bladder cancer were treated with either radiotherapy alone (RT, n=128) or platin based radiochemotherapy (RCT, n=205) after TURB between 5/1982 and 5/1996. Two-hundred and eighty-two curative patients, with either muscle invasive or T1-high risk cancer, were analyzed. Median age was 66 years, median follow-up is 7.5 years. Uni- and multivariate analysis was performed for age, grade, R-status after initial TURB, T-category and treatment modality relevant to the endpoints initial response, survival and bladder preservation.ResultsTreatment related mortality was below 1%. Complete remissions were achieved at 57%, 70%, and 85% after RT or RCT with carbo- or cisplatin. This difference was multivariately significant. Further significant prognostic factors were pT-category and R-status. For all patients survival was 59% and 43% after 5 and 10 years. 79% of survivors could keep their own bladder. Five-year survival rates after RT alone, RCT with carbo- or cisplatin were 47%, 57%, and 69%, respectively. This was univariately significant. The only multivariately significant factor for survival and bladder preservation was the R-status after initial TURB.ConclusionsTreatment of bladder cancer by TURB and RT/RCT is an alternative to primary cystectomy. The addition of chemotherapy leads to significantly more complete remissions and better survival. Initial TURB is recommended to be as radical as possible.ZusammenfassungZielMultivariate Analyse prognostischer Faktoren für Überleben und Blasenerhalt nach Radiochemotherapie des Harnblasenkarzinoms.Patienten und MethodeZwischen Mai 1982 und Mai 1996 wurden an der Strahlentherapeutischen Universitätsklinik Erlangen 333 Patienten wegen eines Harnblasenkarzinoms behandelt. Nach einer transurethralen Resekii on (TURB) erhielten sie entweder eine alleinige Radiotherapie (RT, n = 128) oder eine platinhaltige simultane Radiochemotherapie (RCT, n= 205). 282 kurative Patienten mit muskelinvasiven oder T1-high-risk-Tumoren wurden analysiert. Das mediane Erkankungsalter betrug 66 Jahre, die mediane Nachbeobachtung 7,5 Jahre. Mit den Einflußgrößen Alter, Differenzierungsgrad, R-Status, T-Kategorie und Behandlungsart (RT vs. RCT) wurden für die Endpunkte initiale Remission, Überleben und Blasenerhalt uni- und multivariate Analysen durchgeführt.ErgebnisseTherapieassoziiert starb ein Patient. Nach alleiniger RT, RCT mit Carbo- bzw. Cisplatin wurden komplette Remissionen von 57%, 70% und 85% erreicht. Dieser Unterschied war multivariat signifikant. Weitere signifikante Faktoren waren pT-Kategorie und R-Status. Für alle Patienten fand sich ein Überleben von 59% bzw. 43% nach fünf und zehn Jahren. 79% der Überlebenden weisen eine eigene funktionierende Blase auf. Univariat signifikant unterschieden sich die Überlebensraten nach RT. RCT mit Carbo- oder Cisplatin (47%, 57% und 69%). Der einzige multivariat signifikante prognostische Faktor war der R-Status nach initialer TURB.SchlußfolgerungenDie Strahlentherapie des Blasenkarzinoms nach TURB ist eine Alternative zur primären Zystektomie, da sie bei vergleichbaren Überlebensraten bei 79% der Patienten zum Organerhalt führt. Die der RT/RTC vorausgehende TURB muß so radikal wie möglich durchgeführt werden.

Guided e-MRI prostate biopsy can solve the discordance between Gleason score biopsy and radical prostatectomy pathology.

INTRODUCTION The aim of this study is to examine if guided prostate biopsies based on abnormalities detected by conventional and functional endorectal magnetic resonance imaging (MRI) yield a more reliable representation of the radical prostatectomy pathology and to identify probable preoperative clinical variables that stratified patients likely to harbor significant upgrading. PATIENTS AND METHODS From April 2004 to April 2009, a review of N=70 patients records diagnosed with prostate cancer by a 3-6 core guided transrectal ultrasound (TRUS) prostate biopsy based on abnormalities detected by conventional and functional endorectal MRI and who subsequently underwent radical prostatectomy and exhibited a significant upgrading was conducted. Additionally, a multivariate analysis with a significant upgrading as the outcome was performed including the following parameters: prostate specific antigen (PSA) level, clinical stage, prostate size and duration from biopsy to radical prostatectomy. RESULTS A significant upgrading was noted in only 8.5% of patients, with 1.4% exhibiting a significant downgrading and the rest 90.1% exhibiting an exact Gleason score match. No preoperative clinical variables that stratified patients likely to harbour significant upgrading were identified. CONCLUSIONS This type of biopsy method seems to solve the discordance between the biopsy Gleason score and radical prostatectomy pathology regardless of known preoperative clinical variables that can affect it.

Organ-Sparing Treatment of Advanced Bladder Cancer Paclitaxel as a Radiosensitizer

Background and Purpose:Transurethral resection of bladder tumor (TUR-BT) and radiochemotherapy with cisplatin achieve high rates of bladder preservation and survival figures identical to radical cystectomy in muscle-invasive bladder cancers. The authors have investigated the potential use of paclitaxel in a radiochemotherapy protocol for patients with inoperable bladder carcinomas and mainly contraindications to cisplatin.Patients and Methods:Between October 1997 to August 2004, 42 patients (median age 71 years) suffering from muscle-invasive (n = 32) or recurrent (n = 10) bladder cancers were treated with a paclitaxel-containing radiochemotherapy (paclitaxel 25–35 mg/m2 twice weekly) after TUR-BT (R0/1/2/x in n = 18/4/14/3) or cystectomy with residual tumor (n = 3). Five patients received additional cisplatin. Radiation treatment was administered to a total dose of 45–60 Gy.Results:76.2% completed the planned regimen. Adaptations of treatment were mainly required due to diarrhea. Grade 3/4 toxicities occurred in 15/1 patients. Severe renal toxicities did not occur. 28 patients underwent restaging TUR-BT 6 weeks after radiochemotherapy (complete remission/partial remission/progressive disease: n = 24/3/1). Three patients developed a local recurrence and four distant metastases. Seven patients died from tumor, six of other reasons.Conclusion:Radiochemotherapy with paclitaxel was feasible and this bladder approach needs further investigation to evaluate whether paclitaxel could become a substitute for cisplatin.Hintergrund und Ziel:Bei muskelinvasiven Harnblasenkarzinomen erreicht die transurethrale Resektion (TUR-B), gefolgt von einer Radiochemotherapie mit Cisplatin, zu einem hohen Prozentsatz den Blasenerhalt und vergleichbare Überlebensdaten wie die radikale Zystektomie. Die Autoren untersuchten bei Patienten mit inoperablen Harnblasenkarzinomen und Kontraindikationen für Cisplatin den möglichen Stellenwert eines Paclitaxel-basierten Radiochemotherapieprotokolls.Patienten und Methodik:Von Oktober 1997 bis August 2004 wurden 42 Patienten (medianes Alter von 71 Jahren) mit muskelinvasiven (n = 32) oder rezidivierten (n = 10) Blasenkarzinomen mit einer Paclitaxel-haltigen Radiochemotherapie (Paclitaxel 25–35 mg/m2 zweimal wöchentlich) nach TUR-B (R0/1/2/x bei n = 18/4/14/3) oder unradikaler Zystektomie (n = 3) behandelt. Fünf Patienten erhielten zusätzlich Cisplatin. Die Radiotherapie wurde bis zu einer Gesamtdosis von 45–60 Gy appliziert.Ergebnisse:76,2% der Patienten beendeten wie geplant das Protokoll. Abweichungen waren hauptsächlich wegen Diarrhö erforderlich. Grad-3/4-Akuttoxizitäten waren bei 15/1 Patienten zu verzeichnen. Schwerwiegende renale Toxizitäten traten nicht auf. Bei 28 Patienten wurde eine Kontroll-TUR-B 6 Wochen nach der Radiochemotherapie durchgeführt (komplette Remission/partielle Remission/Krankheitsprogress: n = 24/3/1). Bei drei Patienten traten Lokalrezidive und bei vier Patienten Fernmetastasen auf. Sieben Patienten verstarben tumorbedingt, sechs aus anderen Gründen.Schlussfolgerung:Die Radiochemotherapie mit Paclitaxel war in diesem Konzept durchführbar. Weitere Untersuchungen sind erforderlich, um Paclitaxel als Alternative zu Cisplatin zu evaluieren.