Bladder‐sparing, combined‐modality approach for muscle‐invasive bladder cancer

Abstract

BACKGROUND. The authors evaluated their long‐term experience with combined‐modality, conservative treatment in patients with muscle‐invasive bladder cancer. METHODS. In total, 121 patients with T2, T3, or T4 bladder cancer (mean age, 63 years; ratio of men to women, 3:1) underwent induction by transurethral resection (TUR) of the tumor and received 2 cycles of neoadjuvant chemotherapy followed by radiotherapy (RT) (n = 43 patients) or radiochemotherapy (RCT) (n = 78 patients). Six weeks after RT or RCT, responses were evaluated by restaging TUR. Patients who achieved a complete response (CR) were observed at regular intervals. In patients who had persistent or recurrent invasive tumor, further treatment was recommended. RESULTS. Local response evaluation by restaging TUR was possible in 119 patients, and 102 of those patients (85.7%) achieved a CR. After a median follow‐up of 66 months (range, 6–182 months), no local or distant disease recurrences were observed in 67 of 102 complete responders (65.7%), 17 of 102 complete responders (16.7%) experienced superficial local disease recurrence, and 18 of 102 complete responders (17.6%) had a muscle‐invasive relapse. The 5‐year tumor‐specific, overall, and bladder‐intact survival rates were 73.5%, 67.7%, and 51.2%, respectively. Treatment modality, tumor classification, and resection status after initial TUR had an impact on survival rates (P = .04, P = .02, and P = .02, respectively). CONCLUSIONS. The current results indicated that conservative combined treatment is a reasonable alternative to radical cystectomy in selected patients with muscle‐invasive bladder cancer. Cancer 2008. © 2007 American Cancer Society.

Treatment Results of Radiation Therapy for Muscle-Invasive Bladder Cancer

“…Bladder-preserving strategies such as radiotherapy and radiochemotherapy combined with a transurethral resection of the bladder tumor (TURBT) have been shown to offer an attractive alternative to radical cystectomy providing complete response rates of 60-85%, 5-year survival rates of 50-60%, and survival rates with an intact bladder of 40-45% [24,25,34,35,40,51]. Although there are no randomized trials comparing radical cystectomy with bladder-preserving therapy, long-term data show that overall and disease-specific survival rates in radical cystectomy series of patients with T2-T4a tumors are comparable to those achieved by bladder-preserving strategies [7,14,27,28].…”

“…At the time of diagnosis, 20% of patients present with muscle-invasive tumors, and without treatment > 85% of patients with invasive disease succumb to their disease within 2 years after diagnosis [49]. The standard therapy for patients with muscle-invasive cancer in most institutions is still radical cystectomy and pelvic lymphadenectomy providing 5-year overall survival rates of 60% [47,49].New surgical techniques emerged rapidly during the last years with the development of continent orthotopic urinary diversion and nerve-sparing techniques to improve both functional results and quality of life [3,4,18], but even the construction of a neobladder cannot substitute for the original urinary bladder.Bladder-preserving strategies such as radiotherapy and radiochemotherapy combined with a transurethral resection of the bladder tumor (TURBT) have been shown to offer an attractive alternative to radical cystectomy providing complete response rates of 60-85%, 5-year survival rates of 50-60%, and survival rates with an intact bladder of 40-45% [24,25,34,35,40,51]. Although there are no randomized trials comparing radical cystectomy with bladder-preserving therapy, long-term data show that overall and disease-specific survival rates in radical cystectomy series of patients with T2-T4a tumors are comparable to those achieved by bladder-preserving strategies [7,14,27,28].…”

Bladder preservation in the treatment of muscle-invasive bladder cancer

“…In contemporary series, 5-and 10-year overall survival for radical cystectomy is reported between 45% to 60% and 37% to 45%, respectively [2][3][4][5][6][7]. The 5-year overall survival for bladder preservation using trimodality therapy falls within a similar range at 36-74% [25,[27][28][29]33,36,37,[46][47][48][49][50]. Currently, bladder preservation appears to be a viable alternative to radical cystectomy in patients who may be poor surgical candidates or in those who may opt not to undergo radical cystectomy.…”

Izominvazív hólyagrák képvezérelt sugárkezelése intravesicalisan befecskendezett lipiodolos jelöléssel. A hólyagmegtartó kezelés új lehetősége

“…Napjainkban a szervmegtartó eljárás válogatott betegeknél a radikális cystectomia kuratív alternatívája. A közölt adatok alapján hólyagmegtartó kezelést követően az ötéves teljes túlélés 50-63%, a túlélők 70-80%-ánál működőképes hólyag őrizhető meg [3][4][5][6]. Ugyanakkor randomizált vizsgálatok hiányában mindmáig a radikális cystectomia az első választandó kuratív kezelés a nemzetközi irányel-vek szerint.…”