Organ-sparing treatment of invasive transitional cell bladder carcinoma

To assess the effectiveness of two approaches of organ-sparing treatment in patients with invasive transitional cell bladder carcinoma.

During the period from June 1996 to June 2000, 33 patients with invasive transitional cell carcinoma (T2-4) of the bladder were treated. Patients were divided into two groups. Group A included 17 patients treated with CMV systemic chemotherapy (methotrexate 30 mg/m(2) and vinblastine 3 mg/m(2), day 1; and cisplatin 70 mg/ m(2), day 2) repeated every 3 weeks for 3 courses, combined with intravesical BCG. Complete responders (CR) received maintenance intravesical BCG, while partial responders (PR) were subjected to transurethral bladder resection (TURB) or partial bladder resection. Group B included 16 patients treated with maximal TURB followed by 2 CMV courses and radiotherapy.

Group A patients have been followed-up for a period of 7 to 48 months (median 21.6 months). After completing the 2nd chemotherapy course, 2 patients refused further treatment and were excluded from the group. On completing chemoimmunotherapy 11 (73%) patients showed objective response (CR+PR) and preservation of the bladder was achieved. Four (27%) patients were treatment failures. Group B patients have been followed for a period of 9 to 47 months (median 27.5 months). On completing treatment 12 of 16 (75%) patients showed an objective response with preservation of the bladder. Treatment failure was diagnosed in 4 (25%) patients. The 2 groups differed significantly in terms of side-effects, which were more pronounced in Group B patients. Of the late complications in Group B a serious problem was the development of severe radiation-induced fibrosis leading to microcystis and a cystectomy was indispensable in one of the patients.

The applied 2 approaches of combined organ-sparing treatment of invasive bladder carcinoma seem equally effective. Future randomized studies are needed to define reliable criteria for patient selection.