PD51-07 ONCOLOGIC AND FUNCTIONAL EFFECTIVENESS OF NEOADJUVANT CHEMOTHERAPY FOLLOWED BY EITHER BLADDER-SPARING SURGERY PLUS CONCURRENT CHEMORADIOTHERAPY OR CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER

Abstract

INTRODUCTION AND OBJECTIVE: Previous researches indicated Neoadjuvant Chemotherapy (NAC) achieved optimistic tumor degrading and bladder preservation rates in muscle-invasive bladder cancer (MIBC). However, maximum Transurethral Resection of Bladder Tumor (TURBT) was mostly performed before NAC which might impact oncologic effect of NAC. Our aim was to assess the real effect of NAC for MIBC before TURBT, then bladder preservation rate and quality of life. METHODS: Patients with clinical T2-4N0M0 bladder cancer confirmed by imagings and biopsy, were enrolled from September 2015 to September 2018. 3 or 4 courses of NAC were performed with Gemcitabine/Cisplatin (GC) regimen. Imagings, urine cytology and TURBT were underwent to assess NAC effect. Responders received bladder-sparing treatments including chemoradiotherapy or partial cystectomy followed by Bacillus Calmette-Guerin (BCG) instillation, but salvage cystectomy if recurrence. Others received radical cystectomy. The endpoints included overall survival (OS), bladder preservation rates and life quality. RESULTS: 59 patients (53 men & 6 women) were enrolled with a median age of 63 years. Numbers of patients at each clinical stage were: cT2 15, cT3 39, cT4 5. All pathologies of biopsy were urothelial carcinoma. The complete response (CR) rate of NAC was 10.2% (6/59) and an additional 52.5% (31/59) experienced a partial response (PR), for an overall response rate (ORR) of 62.7%. Of these 37 cases, 94.6% received combined-modality treatments of bladder preservation including TURBT plus chemoradiotherapy (42.4%), TURBT plus BCG (6.8%), TURBT (3.4%), and partial cystectomy plus pelvic lymphadenectomy (6.8%). With a median follow-up of 28.3 months, the 3-year OS was 71.2%. 59.3% (35/59) successfully preserved bladder and the OS was 88.0%, besides relapse-free survival (RFS) was 70.5%. In SF-36 questionnaires, patients had favorable scores of total physical (59 ± 6.11) and tmental (55 ± 5.44) health. As for preserved bladder function, the results of OABSS were satisfied. CONCLUSIONS: NAC had a good efficacy in MIBC. Responders can choose combined-modality treatments for bladder preservation, resulting in satisfied bladder-sparing rate, fair prognosis and quality of life. Source of Funding: 2015 Beijing Hope Run Special Fund of China Cancer Research Foundation