Radiation Therapy and Chemotherapy in Treating Patients With Stage I Bladder Cancer

DISEASE CHARACTERISTICS:

• Pathologically (histologically or cytologically) diagnosis of carcinoma of the bladder within 105 days prior to registration.

  • Patients with operable tumors that are primary high grade urothelial carcinoma of the bladder exhibiting histologic evidence of invasion into the lamina propria (disease clinical stage T1) or a high grade stage Ta urothelial carcinoma without hydronephrosis.
  • Patients with disease involvement of the prostatic urethra with urothelial carcinoma and have no evidence of stromal invasion of the prostate. If the patient's initial tumor was a high grade Ta urothelial carcinoma then his/her recurrent tumor must be a high grade stage T1 urothelial carcinoma to be eligible.
  • Patients must have a high grade urothelial carcinoma stage Ta or T1 that has recurred within 540 days after completion of the initial treatment (transurethral resection bladder tumor [TURBT] and intravesical bacillus Calmette-Guerin [BCG] immunotherapy) or have presented to a participating urologist who judged BCG therapy is contraindicated because this patient may be immuno-compromised or because the patients refuses BCG therapy
• No confirmed tumor-related hydronephrosis
• No pN+ or > T1 disease

• No histologically or cytologically confirmed node metastases

  • If radiologic evaluation of a lymph node is interpreted as "positive", this must be evaluated further either by lymphadenectomy or by percutaneous needle biopsy
• No evidence of distant metastases
• Patients for whom radical cystectomy is the standard next therapy per urologic guidelines, in the judgement of the participating urologist, are eligible
• Must have an adequately functioning bladder as judged by the participating urologist and radiation oncologist and have undergone a visibly complete re-staging TURBT by the participating urologist that shows (or is present on the outside pathology specimen) a T1G2 or T1G3 tumor with uninvolved muscularis propria in the specimen and, if on prostatic urethral biopsy mucosal carcinoma is present, there is no evidence on biopsy in the prostatic stroma of tumor invasion

PATIENT CHARACTERISTICS:

• Zubrod performance status 0-1
• White blood cell count (WBC) ≥ 4,000/mm^3
• Absolute neutrophil count (ANC) ≥ 1,800/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention allowed)
• Serum creatinine ≤ 1.5 mg/dL
• Serum bilirubin ≤ 2.0 mg/dL
• Glomerular filtration rate (GFR) > 25 mL/min (for patients receiving cisplatin, GFR > 60 mL/min)
• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception
• Able to tolerate systemic chemotherapy combined with radiotherapy and a radical cystectomy (if necessary), in the opinions of the urologist, radiation oncologist, and medical oncologist
• No prior or concurrent malignancy of any other site or histology (except for nonmelanomatous skin cancer, T1a prostate cancer, or carcinoma in situ of the uterine cervix) unless the patient has been disease-free for ≥ 5 years

• No severe, active co-morbidity including any of the following:

  • Unstable angina and/or congestive heart failure that required hospitalization within the past 6 months
  • Transmural myocardial infarction that occurred within the past 6 months
  • Acute bacterial or fungal infection requiring IV antibiotics at the time of registration
  • Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding any study therapy at the time of registration
  • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
  • AIDS based upon the current Centers for Disease Control definition (HIV testing not required)
• No prior allergic reaction to cisplatin, mitomycin, or 5-fluorouracil

PRIOR CONCURRENT THERAPY:

• No prior systemic chemotherapy for bladder cancer
• Prior chemotherapy for a different cancer allowed
• No prior radiotherapy to the region of this cancer that would result in overlap of radiotherapy fields
• No concurrent drugs that have potential nephrotoxicity or ototoxicity (e.g., aminoglycoside)