الفهرس 
ACKNOWLEDGEMENTS
ETIOLOGY AND RISK FACTORSOnly 14 pages are availabe for public view
 |  | from | 108 |  |  |
| | | from | 108 | | |
Abstract
Muscle invasive bladder cancer is one of most aggressive urothelial tumors, with a high rate of early systemic dissemination. Five years survival rates depend principally on pathologic stage and nodal status. With increasing T stage the prognosis worsens. Failure is usually owing to occult metastatic disease that is present at the time of initial diagnosis {Core et al, 2007}. The rationale for giving chemotherapy before cystectomy is based on the intent to down stage locally advanced tumors and to treat micro-metastases {Sternberg et al,2002}. This study was conducted to test the efficacy and tolerability of neoadjuvant chemotherapy in locally advanced bladder cancer in our locality. It had been -carried out patients with (T3b-T4a, N0-N2, and M0) transitional cell carcinoma (TCC) of the urinary bladder presented to Urology-Oncology departments Assiut University Hospitals, between September 2013 and September 2014. The study included 22 patients with of urinary bladder, treated with 3 cycles of Cisplatin-Gemcitabine. Six patients (28.6%) achieved complete clinical response (cCR) as evaluated by CT scans. Partial response (PR) was found in 6 patients (28.6%), So the overall survival rate was found in 12 (57.1%) patients, it was significantly associated with T3 tumors six patients (28.6%) showed stable disease (SD). progressive disease (PD) was found in 3 patients (14.3% ). Patients ≤ 60 years significantly showed a good response than patients > 60 years. Smoking was significantly found to be affecting the response, as the all patients ( 8 patients ) whom are known to be non-smokers showed good response ( 5 patients showed CR and 3 patients showed PR ). There are six patients were associated with squamous differentiation, five (83 %) of them showed good response ( 2 CR + 3 PR ). Eighteen patients (81%) completed 3 Cycles of Cisplatin + Gemcitabine. Chemotherapy was Stopped in 3 patients after the second cycle due to local progression and distant metastasis. One patient was died at home during second cycle with unknown cause, her age was 71 years with pT4a/N2/M0 tumor. She had no complication related to chemotherapy. four patients (18.1%) had grade 2 neutropenia , while one patients (0.09%) had grade 1 neutropenia. Chemotherapy induced anemia happened in two patients. One patient had grade I , and one patient had grade II anemia. Grade I Thrombocytopenia was found in 1 patients. And one case developed grade II thrombocytopenia. As regard to non-hematological toxicity three patients had grade II vomiting (2- 5/24hours). Only one case developed grade III vomiting. Grade I weight loss occurred in one patient and Grade I neurosensory toxicity (tingling) occurred in one patient. This study indicates that in spite of a relatively small number of patients. Neoadjuvant Cisplatin +Gemcitabine is a relatively tolerable and effective treatment for patients with locally advanced TCC of urinary bladder before definitive treatment. The results of this study were nearly similar to the results of other studies concerned with neoadjuvant chemotherapy for locally advanced bladder cancer.