title: Trimodality bladder-sparing approach without neoadjuvant chemotherapy for node-negative localized muscle-invasive urinary bladder cancer resulted in comparable cystectomy-free survival.
abstract: BACKGROUND
  To retrospectively review the efficacy and organ preservation experience for muscle-invasive bladder cancer by trimodality therapy at our institution.
  
  
  METHODS
  Between July 2004 and February 2012, seventy patients (M/F = 55/15; median age = 69 years) of lymph node negative localized muscle-invasive bladder cancer were treated primarily with trimodality approach including transurethral resection of bladder tumor (TURBT) prior to combined chemotherapy and radiotherapy (CCRT). Radiotherapy consisted of initial large field size irradiation with 3D conformal technique (3D-CRT), followed by cone-down tumor bed boost with intensity modulated radiotherapy (IMRT) technique. The median total doses delivered to bladder tumor bed and whole bladder were 59.4Gy and 40.0Gy, respectively. No patient received neoadjuvant chemotherapy (NAC). Weekly cisplatin was administered during radiotherapy. Toxicity was scored according to the RTOG criteria. Tumor response was evaluated both cystoscopically and radiographically 3 months after treatment.
  
  
  RESULTS
  The numbers of patients with T2, T3 and T4 lesions were 41, 16 and 13, respectively. Overall survival (OS) and progression-free survival (PFS) at 2 and 5 year were 65.7%, 51.9% and 50.8%, 39.9%, respectively, after a median follow-up time of 24 months. Local-regional control and distant metastasis free survival at 2 year were 69.8% and 73.5%, respectively. Complete response (CR) rate assessed three month after CCRT was 78.1%. Ten patients (20%) had local recurrence after initial CR (n = 50), 3 of them were superficial recurrence. One patient underwent radical cystectomy after recurrence. The overall 5-year bladder intact survival was 49.0% (95% CI, 35.5% to 62.5%). Acute toxicities were limited to grade 1-2. One patient developed late grade 3 GU toxicity.
  
  
  CONCLUSIONS
  Our result suggested that trimodality bladder-sparing approach without NAC or dose-intensification could be well-tolerated with a high CR rate and bladder preserving rate for muscle-invasive bladder cancer.
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Lee
authors.forename: Kai-Lin
authors.initials: KL
authors.lastname: Yang
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Ko
authors.forename: Rong-Yau
authors.initials: RY
authors.lastname: Huang
authors.forename: Pei-Pin
authors.initials: PP
authors.lastname: Tsai
authors.forename: Ming-Tsun
authors.initials: MT
authors.lastname: Chen
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lin
authors.forename: Thomas I-Sheng
authors.initials: TI
authors.lastname: Hwang
authors.affiliation: Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, No, 95, Wen-Chang Road, Shih-Lin District, Taipei City, Taiwan. M000733@ms.skh.org.tw.
authors.forename: Guang-Dar
authors.initials: GD
authors.lastname: Juang
authors.forename: Kwan-Hwa
authors.initials: KH
authors.lastname: Chi
mesh_terms: D000009:Abdominal Muscles / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*