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Abstract
Introduction. Cisplatin-based neoadjuvant chemotherapy (NACT) prior to radical cystectomy (RC) reduces mortality from tumor progression by 33% and achieves complete pathological response (pCR) in one-third of patients. However, the comparative efficacy of different cisplatin dosing regimens remains understudied.
Aim. To evaluate pCR rates following NACT in muscle-invasive bladder cancer (MIBC) patients comparing two cisplatin dosing regimens (40 mg/m² vs 70 mg/m²).
Materials and Methods. We analyzed 60 NACT cases preceding RC at the Department of Oncourology of the N.N. Petrov National Medicine Research Center of Oncology (January 2015-September 2024). Patients were stratified into two groups: Group A (n=39): split-dose cisplatin (40 mg/m² over 2 days) and group B (n=21): standard cisplatin (70 mg/m² single dose). All patients were scheduled for RC upon completion of NACT. The cohort included patients with stage II (36.7%, n=22), stage IIIA (46.7%, n=28), locally advanced stage IIIB (10.0%, n=6), and stage IVB disease (6.7%, n=4) with M1b bone metastases identified during NACT and managed within a multimodal treatment approach. Analysis followed intent-to-treat principles.
Results. The groups were compared by baseline characteristics. Mean treatment duration for both groups: 10.76±4.38 weeks (95% CI 9.63-11.89; p=0.085). Median cycles: 3 (range 1-6); Group B required more cycles (median 4, p=0.032). Comparable cisplatin dose density (Group A: 42 mg/week vs Group B: 35 mg/week, p=0.061). RC performed in 40 patients: pCR rate: 10.0% (n=6); downstaging to <ypT2N0: 25.0% (n=15). No significant differences in pathological staging (pTNM) between groups.
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