Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience

Abstract

Background & objective: Bladder preservation therapy (BPT) using a trimodality approach represents an alternative option to cystectomy inmuscle-invasive bladder cancer (MIBC) patients, also a treatment option in non-cystectomy candidates. The objective of this study was to evaluate BPT using a trimodality approach composed of maximum TURBT, neoadjuvant chemotherapy, followed by chemoradiotherapy, regarding the overall survival (OS), progression free survival (PFS), locoregional progression free survival (LPFS) and treatment toxicity. Patients & methods: This prospective study involved 47 patients with pathologically proven MIBC (T2-T4a N0M0). The study involved muscle invasive bladder cancer patients who refused or were not cystectomycandidates. Patients enrolled received neoadjuvant 3cycles of Gemcitabine/Cisplatin, each cycle was every 21 days. Gemcitabine at 1000mg/m² on days 1&8 and cisplatin at 70mg/m² on day1, followed by Concurrent chemordiotherapy with cisplatin weekly (40mg/m2). Radiation therapy included the whole bladder by 3D conformal planning to a dose of 64Gy/32Fxs. Results: Of the 47 patients, 25 (53.2%) patients expressed complete response (CR), while 22(46.8%) patients had incomplete response. The 4-year OS, PFS, and LPFS rates were 48%, 38%, and 42%, respectively. Acute genitourinary (GU) toxicity of Grade 1 and 2 occurs in 54% and 24%of patients, respectively, while acute gastrointestinal (GI) toxicity (colic &diarrhea) of Grade 1 and 2 occurs in 27.7% and 10.6 %of patients, respectively. Conclusion: For MIBC patients who are non-cystectomy candidates, or who are motivated to maintain their bladders, trimodality bladder preservation therapy (BPT) can be considered as an effective alternative to radical cystectomy.