Single Institutional Experience of Bladder-Preserving Trimodality Treatment for Muscle-Invasive Bladder Cancer

Abstract

The authors designed this study to determine the clinical effectiveness of trimodality treatment, i.e., transurethral resection of a bladder tumor (TURBT) and concurrent chemoradiotherapy (CRT). Twenty patients with a muscle-invasive bladder cancer were treated by TURBT followed by concurrent cisplatin (75 mg/m 2 day), administered on weeks 1 and 4 of radiotherapy. According to residual tumor status after TURBT, patients were classified into patients with a complete TURBT group and incomplete TURBT group. Response to treatment was evaluated by restaging TURBT at 4 weeks after completing CRT (post-CRT). Fifteen patients (75%) achieved complete remission (CR) at restaging; 10 patients (50%) remained continuously free of tumor recurrence. Disease-specific and overall survivals were 51.1% and 38.6% at 5 yr post-CRT, respectively. Of 16 patients in the complete TURBT group, 14 patients (87.5%) achieved CR, which was significantly different from that observed in the incomplete TURBT group, in which only 1 (25%) of 4 patients achieved CR (p=0.032). Five-year disease-specific and overall survivals were 71.6% and 53.5%, respectively. Ten patients (90.9%) maintained their own bladder among the 11 surviving patients. Trimodality treatment was found to be an effective treatment in patients who underwent complete TURBT for a muscle-invasive bladder cancer.

Selective bladder preserving treatment by radiation therapy concurrent with either paclitaxel and cisplatin or cisplatin alone following a transurethral surgery

“…Thus, several studies were done to identify the predictors for ideal candidates for tri-modality treatment. Similar to previous studies [13][14][15]18,21,24,33,43,44], our study showed that completeness of TUR, PS, response to induction treatment and TNM stage were the main factors affecting survival. However, multivariate analysis showed that TNM staging was the main survival predictor.…”

“…The optimum combination of chemotherapeutic drugs needs to be identified not only to improve efficacy but also to minimize toxic effects related to treatment [9]. In our study the rate of CR in group I and II was 80% and 86.7% respectively which is comparable to previous studies [15][16][17][18][19][20][21][22][23][24], while, other studies showed lower CR rate and this is explained by that the majority of our patients were T2. [9,[25][26][27][28][29][30][31].…”

Management of local recurrences in the irradiated bladder: a systematic review

“…From the literature we identified 17 studies that discussed the management of patients who had a complete response to CRT. A summary of the 17 studies [2–18] is shown in Tables 1 and 2. Table 1 shows the response and local recurrence rates after bladder conservation therapy and Table 2 shows the management and outcomes of local recurrences after bladder conservation therapy.…”

Radiotherapy in localized bladder cancer: what is the evidence?

“…Patients were deliberately selected for RCT with favourable disease factors; 92% of patients appeared to have cT2 disease, and only 10% Tis TCC [34]. Similar results were seen in a smaller study of 20 patients from Korea published in 2008 combining 45-65 Gy radiotherapy with concurrent cisplatin [35].…”