Selective Bladder Preservation Using Chemo-Radiotherapy in Treatment of Muscle Invasive Bladder Cancer

Abstract
Background: This study evaluated the outcomes of patients with muscle-invasive bladder cancer (MIBC) stage T2-4a managed by tri-modality therapy by trans-urethral resection (TURB) and concomitant chemo-radiotherapy (CRT).
Aim of Study: We were aiming for preservation of bladder.
Patients and Methods: This study was a prospective randomized clinical trial including 43 patients with MIBC (T2-T4a N0) presented to Clinical Oncology Department, Mansoura University Hospital & Urology center during the period from 5/2008 to 9/2010. Patients were randomized to 2 arms: (I): Included 24 patients, who underwent TURB then concomitant CRT using cisplatin plus paclitaxel, while (II): Included 19 patients received same protocol with cisplatin and 5. Flurouracil. All patients who showed complete response (CR) after induction and consolidation phases were given adjuvant chemotherapy 4 cycles every 3 weeks.
Results: In arm I: 65.2% completed the treatment protocol. In arm II: 63.2% completed the treatment protocol. In arm I: 82.6% showed complete response (CR), 4.3% showed disease progression (DP) & 13% had only partial response (PR). Patients who achieved CR entered the consolidation phase of treatment. In arm II, 78.9% showed CR, 21.1% showed PR. The PFS was 78.26% & 68.42% for both arms respectively. The 3-year OS was slightly better for arm II. The 3-year OS was 60.87% & 68.42% for both arms respectively.
Conclusions: Bladder preservation is a good choice for treatment of MIBC but with good selection of the cases and careful follow up to avoid major toxicities which lead to interruption or stoppage of the preservation protocol.