title: Primary cT2 bladder cancer: a good candidate for radiotherapy combined with cisplatin for bladder preservation.
abstract: BACKGROUND
  Bladder preservation therapy (BPT) has been attempted for patients with localized muscle-invasive bladder cancer. However, the indication for BPT has not yet been established. To identify patients who are good candidates for BPT, we evaluated our long-term experience with chemoradiation therapy (CRT) for bladder preservation.
  
  
  METHODS
  Between 1994 and 2009, 82 patients with bladder cancer (clinical stage T2-N0M0) without concurrent upper urinary tract urothelial cancer were treated with CRT. Before CRT, the patients had a biopsy or resection of the tumor by transurethral resection (TUR). The response to CRT was evaluated by TUR, urine cytology and computed tomography.
  
  
  RESULTS
  Thirty-two cases (39.0%) had a pathological complete response (pCR) that was defined as no microscopic residual tumor in the bladder. After TUR, 69 cases (84.0%) achieved local control of the cancer, which was considered as a clinical complete response (cCR). There was no significant association between achievement of pCR and examined parameters. The long-term results of CRT were evaluated in cCR cases. The median follow-up was 42.8 months (range, 4.1-155.1). The 5-year overall survival rate was 77.7% and 5-year progression-free survival rate was 64.5%. Clinical T stage and type of tumor (primary or recurrence) were predictive factors for overall survival as well as progression-free survival. In addition, primary cT2 cases had significantly better prognosis than cT3-4 and recurrent cases in overall survival and progression-free survival (P= 0.008 and P= 0.046, respectively).
  
  
  CONCLUSIONS
  Cases with a primary cT2 tumor could be good candidates for BPT with radiation combined with cisplatin.
authors: Department of Urology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan. takahara@yamaguchi-u.ac.jp
authors: Takahiko
authors: T
authors: Hara
authors: Jun
authors: J
authors: Nishijima
authors: Yoshihiro
authors: Y
authors: Miyachika
authors: Yoshiaki
authors: Y
authors: Yamamoto
authors: Shigeru
authors: S
authors: Sakano
authors: Hideyasu
authors: H
authors: Matsuyama