title: Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer: a multi-institutional, long-term experience.
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.
authors.affiliation: Comprehensive Urology Unit, National Tumor Institute, G. Pascale Foundation, Naples, Italy.
authors.forename: Sisto
authors.initials: S
authors.lastname: Perdonà
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Brunello
authors.initials: B
authors.lastname: Morrica
authors.forename: Luigi
authors.initials: L
authors.lastname: Gallo
authors.forename: Giustino
authors.initials: G
authors.lastname: Silvestro
authors.forename: Antonio
authors.initials: A
authors.lastname: Farella
authors.forename: Sabino
authors.initials: S
authors.lastname: De Placido
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lorenzo
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000601:surgery / Q000628:therapy*