OncoLog, Volume 57, Number 8, August 2012 Page: 3
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Left: Computed tomography shows a small-cell urothelial tumor (arrow) with lymph node metastases before neoadjuvant chemotherapy.
Right: The same patient was in complete remission and had no tumor remaining at the time of cystoprostatectomy.
related to their cancer to improve in
condition sufficiently to tolerate surgery.
Patients who are not good candi-
dates for surgery may be considered for
a combination of chemotherapy and
radiation. This combination is not con-
sidered as the first option for two rea-
sons. First, radiation therapy does not
appear to have the long-term effective-
ness of surgery. Second, radiation thera-
py may increase the risk of recurrence
in patients with carcinoma in situ,
which is particularly common in the
bladders of people with small-cell
Results of a clinical trial of SCUC
treatment conducted at MD Anderson
prior to the retrospective study suggest-
ed that radiation could have a role in
treating brain metastases. As SCUC
patients survive longer, these metastases
have become more common, affecting
about 50% of survivors who had stage
III or IV disease. Doctors now consider
prophylactic cranial irradiation for
So, what lies ahead for SCUC
research? The nuances of tumor classi-
fication may provide one direction for
new investigations. Puzzlingly, some
bladder tumors that are not classifiable
as SCUC appear to behave much like
small-cell tumors, giving researchers
pause to consider the genetic pathways
involved in tumor development. Dr.
Siefker-Radtke said, "Looking at the
molecular characterization of these
rare tumors and the different genes
that they express might help us to
distinguish between different types
of more traditional-appearing bladder
Communication between re-
searchers and clinicians at different
treatment centers is especially impor-
tant in clinical research involving
SCUC and other rare cancers because
individual institutions may see only
a few cases of a given cancer. Com-
munication between members of multi-
disciplinary treatment teams is also
essential. "Centers should develop a
treatment strategy within their group
and maintain cohesion so that everyone
treats these rare tumors in the same
way," Dr. Siefker-Radtke said. "If we
saw that a treatment regimen or con-
cept didn't work, we would switch
to a different strategy. That's how we
developed our current chemotherapy
regimen for SCUC." Thanks to com-
munication across disciplines and across
institutions, neoadjuvant chemotherapy
is gaining acceptance in SCUC treat-
"There is growing awareness that
neoadjuvant chemotherapy is beneficial
for patients with SCUC, and it's been
the subject of some large meetings and
panel discussions," Dr. Siefker-Radtke
said. "This strategy is gaining traction
and is becoming more accepted as the
standard in treating this rare bladder
FOR MORE INFORMATION
Dr. Arlene Siefker-Radtke.....773-792-2830
Lynch SP, Shen Y, Kamat A, et al.
Neoadjuvant chemotherapy in small
cell urothelial cancer improves
pathologic downstaging and long-
term outcomes: results from a
retrospective study at the MD
Anderson Cancer Center. Eur Urol
2012 Apr 17. [Epub ahead of print]
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University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 57, Number 8, August 2012, periodical, August 2012; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth640047/m1/3/: accessed April 23, 2019), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.