Long-term effects of conservation therapy for muscle invasive bladder carcinoma

Abstract

4519 Background: A review of outcomes of radiotherapy-based bladder conserving therapy in patients with muscle invasive bladder cancer was performed to assess the long term outcomes. Methods: Of 131 patients with T2/T3aN0M0 (TNM 1992) transitional carcinoma of the bladder managed at Princess Margaret Hospital between 1986 and 1997, 108 were treated with radiotherapy alone, 20 with radiotherapy plus concurrent cisplatin and 3 with neoadjuvant chemotherapy plus radiotherapy. Response was assessed with cystoscopy 6 weeks after completion of treatment. Salvage cystectomy was offered as appropriate to patients who failed to achieve CR or relapsed locally (32% were considered unfit for surgery). Results: Overall CR rate was 72.5%. Overall survival (OS), cause specific survival (CSS) and local relapse free rates (LRFR) at 5 years were 44%, 58% and 49% respectively. For 95 patients that achieved CR, LRFR at 5 and 10 years was 59% at median follow up of 4.8 years (0.7–15.7). Of 47 patients with recurrent disease, 31 relapsed in the bladder only, 3 in bladder and pelvis, 2 in bladder and metastases, and 10 with metastases only. Salvage treatment for those with bladder only relapse (n=31) consisted of TUR/intravesical BCG in 52% (n=16) and cystectomy in 31% (n=11). Cumulative relapse rate was 42% at 3 years and 53% at 5 years; only 1 patient relapsed after 5 years. Those unfit for surgery had lower OS (p<0.01) and CSS (p=0.04). Prognostic factors for improved CSS and LRFR included absence of CIS, small primary tumor (≤2cm); patients who received chemotherapy had improved CSS. Only 19 of 131 pts had cystectomy for failure of local control. Conclusions: RT based treatment of locally advanced bladder cancer results in bladder preservation in the majority of patients with T2-T3a N0M0 (TNM 1992) bladder cancer. For patients who achieve CR, relapse beyond 5 years is uncommon. For select patients bladder conservation therapy with multimodality approach is an alternative to radical cystectomy. No significant financial relationships to disclose.