Radiation Therapy and Concomitant Paclitaxel/Carboplatin Chemotherapy for Muscle Invasive Transitional Cell Carcinoma of the Bladder: A Well-Tolerated Combination R. Charles Nichols, Jr., M.D., 1 * Matthew G. Sweetser, M.D., 2 Syed K. Mahmood, M.D., 3 Fernando C. Malamud, M.D., 2 Neal P. Dunn, M.D., 4 John P. Adams, M.D., 5 James S. Kyker, M.D., 6 and Kimberly Lydick, R.N. 1 1 Department of Radiation Oncology, Gulf Coast Cancer Treatment Center, Panama City, Florida 2 Department of Medical Oncology, Gulf Coast Cancer Treatment Center, Panama City, Florida 3 Bay Oncology Center, Panama City, Florida 4 Panama City Urological Center, Panama City, Florida 5 Urologic Surgery, Panama City, Florida 6 Adult and Pediatric Urology, Panama City, Florida SUMMARY This review evaluates tolerance and disease control for eight patients with muscle invasive bladder cancer treated with pelvic radiotherapy and concomitant pacli- taxel/carboplatin chemotherapy. From October 1996 through February 1998, eight pa- tients were treated with pelvic radiotherapy and concomitant paclitaxel/carboplatin che- motherapy. All received from 39.60–41.40 Gy to the pelvis followed by a boost to the initial site of disease. Final tumor doses ranged from 64.80–68.40 Gy. Most patients received paclitaxel at 150 mg/m 2 and carboplatin at an area under the curve (AUC) of 7 at 3-week cycles during the radiation therapy. No patient required treatment interruption. With a median follow-up of 27 months, three patients remain free of local and distant disease at follow-up intervals of 24, 25, and 31 months. No surviving locally controlled patient demonstrated late urinary or gastrointestinal morbidity. All patients with a visibly com- plete transurethral resection of bladder tumor (TURBT) prior to radiotherapy achieved local disease control. For this group of patients, the absolute 2-year pelvic tumor control rate is 57%. The 2-year disease-specific survival is 43%. Paclitaxel/carboplatin chemo- therapy can be delivered with continuous course pelvic radiation therapy without severe acute or apparent late toxicity. This combination also appears to be effective in achieving disease control in the urinary bladder, particularly in those patients who have undergone a thorough TURBT. The authors believe that it would be reasonable to investigate this combination in future bladder conservation protocols. The combination of paclitaxel and carboplatin with radiotherapy may be of particular value in elderly patients or those with renal impairment. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 281–286 (2000). © 2000 Wiley-Liss, Inc. Key words: bladder neoplasms; paclitaxel; carboplatin; radiotherapy *Correspondence to: R. Charles Nichols, Jr., MD, Department of Radiation Oncology, Gulf Coast Cancer Treatment Center, 2100 State Avenue, Panama City, FL 32405. Phone: (850) 763-0036; Fax: (850) 763-0259; E-mail: NICHOLSMD@ aol.com Received 24 August 1999; Revised 28 April 2000; Accepted 13 July 2000 Int. J. Cancer (Radiat. Oncol. Invest): 90, 281–286 (2000) © 2000 Wiley-Liss, Inc. Publication of the International Union Against Cancer