Phase II Evaluation of Carboplatin, Paclitaxel and Gemcitabine Followed by Concurrent Cisplatin and Radiation Therapy in Patients With Locally Advanced or Recurrent Urothelial Malignancy

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically confirmed primary or recurrent invasive carcinoma of the urothelium

- Transitional, squamous, or mixed cell subtypes allowed

- Primary disease site must be the urinary bladder or urethra

- Disease confined to the true pelvis (T2-T4, N0-N3, M0)

- Must meet at least 1 of the following criteria:

- Nodal involvement at or below the level of the bifurcation of the iliac
vessels

- Medically or surgically inoperable

- Patient refused cystectomy

- Measurable or nonmeasurable disease

- Evidence of tumor invasion of the muscularis by cystoscopy and biopsy and detailed
bladder mapping within the past 56 days

- No extrapelvic metastases

- Eligible to receive radiotherapy

- Planned radiotherapy at a SWOG-approved facility

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- Zubrod 0-2

Life expectancy

- Not specified

Hematopoietic

- Granulocyte count at least 1,500/mm^3

- Platelet count at least lower limit of normal

Hepatic

- Bilirubin no greater than upper limit of normal (ULN)

- SGOT or SGPT no greater than 2.5 times ULN

Renal

- Creatinine clearance at least 60 mL/min OR

- Creatinine no greater than ULN

Gastrointestinal

- No chronic diarrhea

- No malabsorption

- No extensive diverticular disease of the colon

- No inflammatory bowel disease

- No other pre-existing gastrointestinal disorders

Other

- Not pregnant or nursing

- Fertile patients must use effective contraception

- No active infections requiring antibiotics

- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated
stage I or II cancer currently in complete remission

PRIOR CONCURRENT THERAPY:

Biologic therapy

- Not specified

Chemotherapy

- No prior chemotherapy for patients with a current diagnosis of advanced bladder
cancer that is also the initial diagnosis

- No prior systemic chemotherapy except adjuvant therapy for recurrent disease
completed more than 6 months ago

- No prior carboplatin

- No prior paclitaxel

- No prior gemcitabine

Endocrine therapy

- Not specified

Radiotherapy

- See Disease Characteristics

- No prior pelvic radiotherapy

Surgery

- See Disease Characteristics

- Recovered from prior surgery