Selective Bladder Preservation by Combined Modality Treatment of Invasive Bladder Cancer: 10 Year Outcome
Presenter: W. U. Shipley
Affiliation: Massachusetts General Hospital
The standard of care for muscle invasive bladder cancer is radical cystectomy +/- adjuvant chemotherapy with or without radiation. However, to improve quality of life in these patients, there is much interest in bladder-conserving therapies, using transurethral surgery and concurrent chemoradiation.
Materials and Methods
190 patients with T2-4a bladder carcinoma (T2=90, T3-4a=100).
Twenty-seven had hydronephrosis.
Following TURBT, patients were treated with various induction regimens consisting of cisplatin based chemotherapy concurrent with radiation.
Following 40 Gy, patients were reevaluated by cytology and biopsy. Those with a CR continued to recieve boost chemoradiation to 64.8 Gy. Those with less than a CR had an immediate cystectomy.
Sixty percent received adjuvant MCV chemotherapy.
Median follow up is 6.7 years.
A total of 121 patients had a CR: 71% of T2 patients and 57% of T3-T4a patients.
Cystectomy was performed in 66 patients (35%).
Overall survival for the entire group was 54% at 5 years and 36% at 10 years.
DSS was 63% at 5 years and 59% at 10 years.
Disease specific survival with retention of bladder was 45% at 5 years and 43% at 10 years.
No patient required cystectomy due to toxicity of treatment.
Long-term OS of 36% and DSS of 59% is comparable to results with traditional therapy of radical cystectomy.
Given this, along with the fact that the majority have full functional use of their bladders, this bladder conserving regimen is an acceptable alternative to cystectomy in those with advanced bladder cancer.
There is a large move toward organ preserving treatment in all oncologic treatment. This is also true for bladder cancer. Although there have been many recent advances giving patients alternatives to urostomy(diversion of the urine to an external pouch), retention of the bladder can be good for many patients in terms of quality of life. Since OS and DSS is comparable to historic data and there was little long term toxicity from bladder conservation therapy, this is an acceptable alternative to cystectomy in motivated patients.