1166 Prospective trial of chemotherapy and radiotherapy for invasive bladder carcinoma: Preliminary results

Abstract

Purpose This study was designed to improve local control and survival rates and to evaluate the possibility and safety of conservative treatment in invasive bladder cancer. Material and methods Between June-89 and March-94, 30 patients with invasive bladder cancer T2–4 Nx Mo, were entered prospectively on a selective bladder-sparing protocol combining aggressive transurethral resection (TUR), CMV chemotherapy and radiotherapy (60 Gy). Radical cystectomy was recommended to patients with residual disease after TUR-CMV. Eight non responders patients who refused surgery were given 66 Gy radiotherapy. Results Among the 90 evaluable patients, 24 (80%) are alive and free of disease (median follow-up of 32 months) and 22 (74%) have functional bladders. Radical cystectomy was performed only in 3 patients. Of the 27 patients who completed full-course chemoradiotherapy, 22 (81.5%) are alive and free of disease at the present time (included 3 who developed ca in situ and were treated successfully with intra vesical therapy). Several prognosis factors, including tumor stage and response to TUR-CMV, were found to be significant predictors of overall survival and distant metastases rate. Conclusions These results confirm that TUR, CMV and radiotherapy may be effective to improve cure rate maintaining a functional bladder. This study was designed to improve local control and survival rates and to evaluate the possibility and safety of conservative treatment in invasive bladder cancer. Between June-89 and March-94, 30 patients with invasive bladder cancer T2–4 Nx Mo, were entered prospectively on a selective bladder-sparing protocol combining aggressive transurethral resection (TUR), CMV chemotherapy and radiotherapy (60 Gy). Radical cystectomy was recommended to patients with residual disease after TUR-CMV. Eight non responders patients who refused surgery were given 66 Gy radiotherapy. Among the 90 evaluable patients, 24 (80%) are alive and free of disease (median follow-up of 32 months) and 22 (74%) have functional bladders. Radical cystectomy was performed only in 3 patients. Of the 27 patients who completed full-course chemoradiotherapy, 22 (81.5%) are alive and free of disease at the present time (included 3 who developed ca in situ and were treated successfully with intra vesical therapy). Several prognosis factors, including tumor stage and response to TUR-CMV, were found to be significant predictors of overall survival and distant metastases rate. These results confirm that TUR, CMV and radiotherapy may be effective to improve cure rate maintaining a functional bladder.