Mangar SA et al. (2004) Small-cell carcinoma of the urinary bladder: 10-year experience. Clin Oncol 16: 523–527

Mangar and colleagues from the UK have recently reported their 10-year experience of treating small-cell carcinoma of the urinary bladder. This rare tumor accounts for only 0.5% of urinary bladder malignancies and so clinical data are scarce.

During the period 1986–1996, the authors treated 14 patients whose median age at presentation was 74 years. All patients presented with stage III or stage IV disease and underwent transurethral resection three were too frail to receive further treatment. Of the remainder, four patients received radical bladder radiotherapy (combined with neoadjuvant chemotherapy in one case), two underwent radical cystoprostatectomy, and five received palliative bladder radiotherapy. Ten (70%) patients died within 2 years of diagnosis. The median survival was 5 months, or 21 months in those who had received radical treatment. Long-term survival was recorded in only one case; this patient had undergone radical cystoprostatectomy and was alive 7 years later.

Mangar et al. conclude that patients presenting with this tumor are usually elderly, and that treatment is often complicated by frailty and comorbidity. Since local therapy alone did not appear to give good results in this series, the authors recommend platinum-based chemotherapy (followed by bladder radiotherapy if appropriate) in patients who are able to withstand treatment. The majority of patients, however, are too frail for this treatment and the authors acknowledge the role of palliative pelvic radiotherapy in achieving durable symptom control.