Abstract
Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.
Highlights
Bladder cancer in Egypt constitutes 30% of all cancer cases treated at Egyptian National Cancer Institute
30 transitional cell carcinoma (TCC) patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT)
Treatment response: We assessed the response to chemo-radiation one month after completion of treatment and we found that 24 patients (80%) had complete remission (CR), two patients had non-muscle-invasive bladder cancer (MIBC), and 4 patients (13%) had residual invasive disease and were subjected to salvage cystectomy
Summary
Patients with muscle-invasive bladder cancer (MIBC) frequently have significant co-morbidities that render them unsuitable for high-risk radical surgery. This group of patients would benefit from a non-surgical therapy that would improve the local control of the bladder cancer [3,4]. Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance.
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