Clinical experience with radiotherapy alone and radiochemotherapy with platin based regimens in organ-sparing treatment of invasive bladder cancer.
OBJECTIVE
To evaluate 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 January 1998 and January 2007, 186 patients with muscle invasive transitional- cell carcinoma (TCC) of the urinary bladder were treated with radiotherapy (RT; n=72), or radiochemotherapy (RCT; n=114) with platin based regimens after transurethral resection (TUR) of the tumor. About 3 to 4 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 58.8 months (range, 3.1 to 100.4 months).


RESULTS
Complete response was achieved in 72.6% of patients. Local control after CR without any relapse was maintained in 70.9% of patients at 5 years. Distant metastases were diagnosed in 50 patients with an actuarial rate of 28.23% at 5 years. Five-year overall survival (OAS) was 64.82% for the whole group of patients, and it was 67.14% for cases who preserved their bladder. Early tumor stage, age <60 years, low tumor grade, absence of pelvic lymph nodes, and a complete TUR were the most important significant factors predicting CR and survival. RCT was more significantly effective than RT alone in development of CR. Salvage cystectomy was associated with a 4.55% disease-free survival rate and 30.78% overall survival rate at 5 years.


CONCLUSIONS
Transurethral resection with radiochemotherapy are reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage, age <60 years, low tumor grade, and absence of pelvic lymph nodes; in whom a complete TUR is accomplished.


BACKGROUND
Bladder cancer - Muscle invasive - Radiochemotherapy - Radiotherapy.
Gamal El-Deen
Hanan Sh
HSh
The Department of Clinical Oncology, Faculty of Medicine, Tanta University Hospital.
Elshazly
Hala F
HF
Abo Zeina
Esam A
EA