Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results.
OBJECTIVE
To evaluate our long-term experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival.


METHODS
Between 1982 and 2000, 415 patients with bladder cancer (high-risk T1, n = 89; T2 to T4, n = 326) were treated with radiotherapy (RT; n = 126) or radiochemotherapy (RCT; n = 289) after transurethral resection (TUR) of the tumor. Six weeks after RT/RCT, response was evaluated by restaging-TUR. In case of complete response (CR), patients were observed at regular intervals. In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended. Median follow-up was 60 months (range, 6 to 199 months).


RESULTS
CR was achieved in 72% of patients. Local control after CR without muscle-invasive relapse was maintained in 64% of patients at 10 years. Distant metastases were diagnosed in 98 patients with an actuarial rate of 35% at 10 years. Ten-year disease-specific survival was 42%, and more than 80% of survivors preserved their bladder. Early tumor stage and a complete TUR were the most important factors predicting CR and survival. RCT was more effective than RT alone in terms of CR and survival. Salvage cystectomy for local failure was associated with a 45% disease-specific survival rate at 10 years. Cystectomy because of a contracted bladder was restricted to 2% of patients.


CONCLUSIONS
TUR with RCT is a reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage and unifocal tumors, in whom a complete TUR is accomplished.
Department of Radiation Oncology, Institute of Pathology, University of Erlangen, Germany. claus.roedel@strahlen.med.uni-erlangen.de
Claus
C
Rödel
Gerhard G
GG
Grabenbauer
Reinhard
R
Kühn
Thomas
T
Papadopoulos
Jürgen
J
Dunst
Martin
M
Meyer
Karl M
KM
Schrott
Rolf
R
Sauer
D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*