title: Long-term results of two prospective bladder-sparing trimodality approaches for invasive bladder cancer: neoadjuvant chemotherapy and concurrent radio-chemotherapy.
abstract: OBJECTIVE
  To report long-term outcomes of selective organ preservation for muscle-invasive bladder cancer (MIBC) using 2 bladder-sparing trimodality approaches.
  
  
  METHODS
  From 1990 to 2010, 80 patients with T2-T4 bladder cancer were prospectively enrolled in 2 successive bladder-sparing protocols. Forty-one patients were treated with neoadjuvant methotrexate, cisplatin, and vinblastine (MCV) chemotherapy followed by radiotherapy (60 Gy) in complete responders (protocol 1 [P1]) and 39 patients were treated with weekly cisplatin concurrent with radiotherapy (64.8 Gy) (protocol 2 [P2]).
  
  
  RESULTS
  The median follow-up was 72 months (range, 9-204 months). Five and 10-year cumulative overall survival for all series were 73% and 60% and the corresponding numbers for cancer-specific survival were 82% and 80%, respectively. Of all surviving patients, 83% maintained their own bladder. Although there were no significant differences in overall survival (P = .820), cancer-specific survival (P = .688) and distant metastasis (P = .417) between protocols, complete response rates (P = .003), and disease-free survival (P = .031) were significantly higher in P2 treatment.
  
  
  CONCLUSIONS
  Trimodality therapy with bladder preservation represents a real alternative to radical cystectomy (RC) in selected patients. Overall survival and cancer-specific survival rates are encouraging with more than 80% of survivors retaining functional bladders.
authors.affiliation: Department of Radiation Oncology Hospital Universitario de la Princesa, Instituto Investigación Sanitaria IP, Madrid, Spain. azapatero.hlpr@salud.madrid.org
authors.forename: Almudena
authors.initials: A
authors.lastname: Zapatero
authors.forename: Carmen
authors.initials: C
authors.lastname: Martin De Vidales
authors.forename: Ramon
authors.initials: R
authors.lastname: Arellano
authors.forename: Yamile
authors.initials: Y
authors.lastname: Ibañez
authors.forename: Gloria
authors.initials: G
authors.lastname: Bocardo
authors.forename: Mar
authors.initials: M
authors.lastname: Perez
authors.forename: Mariano
authors.initials: M
authors.lastname: Rabadan
authors.forename: Feliciano
authors.initials: F
authors.lastname: García Vicente
authors.forename: Jose A
authors.initials: JA
authors.lastname: Cruz Conde
authors.forename: Carlos
authors.initials: C
authors.lastname: Olivier
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D003558:Cystoscopy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents