Primary chemotherapy with or without radiation therapy and/or surgery for children with localized sarcoma of the bladder, prostate, vagina, uterus, and cervix: a comparison of the results in Intergroup Rhabdomyosarcoma Studies I and II

A review of cases of children with cancer in or near the bladder revealed that children with complete surgical resection of the surrounding area enjoyed only a marginal increase in survival over those who received chemotherapy as a primary treatment. Only a quarter of the surgically treated patients who were alive at the end of two years still had their bladder, however. Since the loss of the urinary bladder has significant physical and psychosocial effects, an attempt was made to determine if more aggressive chemotherapy might permit a greater number of children to retain at least a portion of their bladder. A total of 109 children with genitourinary sarcomas were treated in an uncontrolled study in which the individual physician made the therapeutic choice for each patient with the objective of saving the bladder, if possible. The chemotherapeutic regimen consisted of vincristine, dactinomycin, and cyclophosphamide. Radiation and/or surgery was used to treat residual or recurrent tumor. While the three-year survival rate was comparable to a previous study in which the treatment was primarily surgical, the disease-free survival was worse (52 percent compared with 70 percent for the surgically treated patients). After three years, only 22 percent of the surviving patients with bladder or prostate cancer still retained their bladders, which is not significantly different from the 23 percent who retained their bladders with surgery as the primary treatment. The evidence, therefore, suggests that present chemotherapeutic techniques are not effective in permitting the preservation of bladder function in children with genitourinary sarcomas. This does not preclude the possibility that improved chemotherapeutic regimens may make bladder preservation possible. (Consumer Summary produced by Reliance Medical Information, Inc.)