title: [Bladder preservation using chemoradiation therapy for locally invasive bladder cancer].
abstract: OBJECTIVE
  We investigated the long-term results and molecular markers of outcome with selective organ preservation in invasive bladder cancer using chemoradiation therapy.
  
  
  METHODS
  We examined locally invasive bladder cancer in 32 patients (30 men, 2 women; mean age at treatment 68.1 years) who underwent bladder-sparing protocols in the Department of Urology at Sumitomo Hospital between 2000 and 2005. The clinical stage was T2, T3, and T4 in 13, 16, and 3 patients, respectively. Our protocol includes aggressive transurethral resection of the bladder tumor (TURBT) and 46 Gy radiotherapy (2 Gy/fraction, 5 fractions/week) to the pelvis with concurrent cisplatin chemotherapy (20 mg/body/day, 5 days/week, the first and fourth week, intravenously). The initial evaluation included magnetic resonance imaging (MRI), urine cytology, and cystoscopy with a biopsy. During follow-up, if the patients developed superficial recurrence, they was treated with TURBT and intravesical Bacillus Calmette-Guérin (BCG), while patients with invasive recurrence were advised to undergo a salvage cystectomy. We examined the association between the expression of the Bcl-2 family in pretreatment TUR specimens and patient outcome. The mean follow-up was 54.6 months.
  
  
  RESULTS
  The first assessment after the induction chemoradiotherapy showed that bladder preservation was achieved in 27 patients (84.4%). The actuarial local control rate with an intact bladder was 56.3% (18 patients) at 3 years. The 1-, 3-, and 5-year cancer-specific survival rate was 90.6, 84.0, and 66.9%, respectively. The 5-year cancer-specific survival rate was 75.0, 67.2, and 33.3% in T2, T3, and T4, respectively. Bcl-x positivity was significantly associated with a poor cancer-specific survival rate (log-rank test, p = 0.038).
  
  
  CONCLUSIONS
  Chemoradiation therapy for invasive bladder cancer can achieve survival rates similar to those in patients treated with radical cystectomy, with successful bladder preservation. Our results suggest that the expression of Bcl-x is a potential prognostic marker for chemoradiation therapy in invasive bladder cancer.
authors.affiliation: Department of Urology, Sumitomo Hospital.
authors.forename: Toyofumi
authors.initials: T
authors.lastname: Abe
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Yoshioka
authors.forename: Mototaka
authors.initials: M
authors.lastname: Sato
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Sekii
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Itatani
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis*; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D051020:bcl-X Protein / Q000032:analysis*
chemical_list: D000970:Antineoplastic Agents; D001500:BCG Vaccine; D014408:Biomarkers, Tumor; D051020:bcl-X Protein; D002945:Cisplatin