Original article Complete response of bony metastatic bladder urothelial cancer to neoadjuvant chemotherapy and cystectomy Fadi N. Joudi, M.D. a, *, Laila Dahmoush, M.D. b , David M. Spector, M.D. c , Badrinath R. Konety, M.D. a a Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA b Department of Pathology, University of Iowa, Iowa City, IA 52242-1089, USA c Hematology Oncology Consultants, Davenport, IA 52804, USA Received 28 June 2005; received in revised form 19 December 2005; accepted 22 December 2005 Abstract We report on a 38-year-old male diagnosed with biopsy-proven bladder urothelial carcinoma metastatic to the bone, who had a complete response to neoadjuvant chemotherapy consisting of carboplatin and gemcitabine. The final pathology of his radical cystoprostatectomy revealed no residual cancer. The patient continues to be without evidence of disease 2 years postoperatively. This case shows that neoadjuvant chemotherapy with nonstandard regimens can yield responses in patients with bone metastases. © 2006 Elsevier Inc. All rights reserved. Keywords: Urothelial carcinoma; Metastasis; Chemotherapy; Cystectomy; Survival 1. Introduction A 38-year-old male presented to his local urologist with gross hematuria. Work-up revealed a bladder mass with bilateral hydronephrosis. He did not have any palpable mass on physical examination. Computerized tomography showed bony metastases to the spine, confirmed by bone scan (Fig. 1A). Transurethral resection of the bladder tumor revealed high-grade urothelial cancer invading the lamina propria (T1G3 disease) with lymphovascular invasion (Fig. 2); restaging transurethral resection of bladder tumor re- vealed residual tumor with no muscular invasion. The pa- tient then underwent biopsy of a metastatic lesion in his right iliac spine to exclude other primary cancer. Pathology confirmed metastatic urothelial carcinoma (Fig. 3). He sub- sequently received neoadjuvant chemotherapy with 6 cycles of carboplatin and gemcitabine. Repeat computerized to- mography after chemotherapy revealed resolution of the hydronephrosis. Repeat bone scan (Fig. 1B) and bone marrow biopsy of the right iliac spine (Fig. 4) were negative for metastatic disease. He then underwent cystoprostatectomy, pelvic lymph node dissection, and ileal conduit diversion. Pathol- ogy revealed no evidence of residual cancer in the bladder. Repeat imaging postoperatively revealed no evidence of metastases, and the patient continues to be without evidence of disease 2 years postoperatively. 2. Discussion Of patients with bladder cancer, 70% present with su- perficial disease, and the rest present with invasive or ad- vanced disease [1]. However, about 50% of patients diag- nosed with muscle-invasive transitional cell carcinoma and almost all those with distant metastatic spread die of their disease [2]. Patients with superficial bladder cancer (Ta or T1) rarely present with metastases; a review of 1,000 pa- tients with Ta or T1 bladder cancer revealed metastases in only 9 (5 were T1), with bone involved in 5 patients [3]. Urothelial cancer is known to metastasize to the bone, and it can be the most common site of recurrence outside the pelvis, with the spine being the most frequent site involved [4]. Patients with bone metastases are known to have a * Corresponding author. Tel.: +1-319-356-7221; fax: +1-319-356- 3900. E-mail address: fadi-joudi@uiowa.edu (F.N. Joudi). Urologic Oncology: Seminars and Original Investigations 24 (2006) 403– 406 1078-1439/06/$ – see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.urolonc.2005.12.002