1149 Bladder sparing by chemotherapy and radiation in patients with invasive bladder cancer

Abstract

48 consecutive patients (pts) with muscle-invasive bladder cancer were treated between November 1988 and May 1993. All pts had pure transitional carcinoma, absence of diffuse Tis, and clinic N0M0 stage. 39 pts had T2-3a stages and 9 had T3b-4a. The treatment consisted of RTU, neoadjuvant chemotherapy M-VAC (CT) (2–4 cycles), and radiotherapy (RT) (44 Gy). RT was continued to 64 Gy in pts with biopsy-proven absence of invasive cancer (CR). Cystectomy was performed in pts with residual invasive tumor. 9 pts did not receive RT: 6 with failure to CT underwent immediate cystectomy, and 3 with CR received only CT. The CR rate to neoadjuvant treatment was 75%. After a mean follow-up of 35 months, 24 pts (50%) had preserved bladders free of invasive tumor and functioning well. The actuarial survival and disease free survival at 3 years were, respectively, 49% and 56%. Of the 24 currently surviving pts 87% have their bladder preserved. 5 pts required salvage cystectomy for recurrent invasive cancer or diffuse Tis. 9 pts had recurrent superficial bladder tumors, and 5 of them preserved their bladders after further RTU and BCG. The response to CT had prognostic value for survival (P=.0004). Long-term bladder sparing was significantly associated with absence of hydronephrosis and bladder-confined disease (T2-T3a). Severe complications were: 1 death for fulminant hepatitis after CT, 2 late radiation cystitis that required cystectomy, with one death in postoperatory, and colovesical fistula that needed rectosygmoidectomy. The long-term bladder preservation is feasible in a selected group of pts by multimodality treatment. Most surviving pts had their bladders intact.