Abstract
The aim of this study is to access the feasibility, toxicity profile, and tumour outcome of an organ preservation curative approach in non-metastatic muscle-invasive bladder cancer.A retrospective analysis was conducted on patients affected by M0 bladder cancer, who refused cystectomy and were treated with a curative approach. The standard bladder preservation scheme included maximal transurethral resection of bladder tumour (TURBT) and combination of radiotherapy and platin-based chemotherapy, followed by endoscopic evaluation, urine cytology, and instrumental evaluation.Thirteen patients fulfilled the inclusion criteria. TNM stage was cT2cN0M0 and cT2cNxM0, in 12 and one patients, respectively. All patients had transitional cell cancer. Twelve patients completed the whole therapeutic programme (a bimodal treatment without chemotherapy for one patient). Median follow-up is 36 months. None of the patients developed severe urinary or intestinal acute toxicity. In 10 patients with a follow-up > 6 months, no cases of severe late toxicity were observed. Response evaluated in 12 patients included complete response and stable disease in 11 patients (92%), and one patient (8%), respectively. At the time of data analysis (March 2016), 10 patients (77%) are alive with no evidence of disease, two patients (15%) died for other reasons, and one patient has suspicious persistent local disease.The trimodality approach, including maximal TURBT, radiotherapy, and chemotherapy for muscle-invasive bladder cancer, is well-tolerated and might be considered a valid and feasible option in fit patients who refuse radical cystectomy.
Highlights
The standard treatment for muscle-invasive bladder cancer remains radical cystectomy, with removal of bladder, regional lymph nodes and surrounding structures, with urinary diversion [1,2]
Single modality bladder-preservation treatment consisting of transurethral resection of bladder tumour (TURBT), chemotherapy, or radiotherapy yields inferior results in terms of local tumour control and long-term survival [5,6]
Several prospective studies has been conducted over the past two decades showing survival rates of a trimodality approach, comparable to those of radical cystectomy or neoadjuvant chemotherapy followed by cystectomy series [8,9,10,11]
Summary
The standard treatment for muscle-invasive bladder cancer remains radical cystectomy, with removal of bladder, regional lymph nodes (extended lymph node dissection) and surrounding structures (uterus or prostate gland), with urinary diversion [1,2] This procedure is still associated with complication rates of up to 30% and, urinary diversion has a great impact on long-term urinary, gastrointestinal, and sexual function, decreasing significantly the patient’s quality of life [3,4]. Several prospective studies has been conducted over the past two decades showing survival rates of a trimodality approach, comparable to those of radical cystectomy or neoadjuvant chemotherapy followed by cystectomy series [8,9,10,11] This combined treatment is based on maximal TURBT, followed by radiotherapy and concurrent chemotherapy
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