S0121, Neoadjuvant Carboplatin, Paclitaxel, and Gemcitabine Followed by Cisplatin and Radiation Therapy in Treating Patients With Locally Advanced or Recurrent Carcinoma of the Urothelium

You may be eligible if

• 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