Upper Egypt experience in bladder preservation using concurrent chemoradiotherapy

Area of Science:

• Oncology
• Urology

Background:

• Muscle invasive bladder cancer (MIBC) necessitates aggressive treatment, often involving radical cystectomy.
• Bladder preservation strategies aim to maintain organ function while effectively treating MIBC.

Purpose of the Study:

• To report on bladder preservation experiences in Upper Egypt using distinct treatment protocols at Assiut and Sohag Universities.
• To evaluate the efficacy and prognostic factors associated with bladder preservation in MIBC.

Main Methods:

• Sohag study: Transurethral resection (TUR) followed by radiochemotherapy (5-fluorouracil and cisplatin) for operable MIBC.
• Assiut study: Maximum safe resection followed by chemoradiotherapy (60 Gy radiotherapy, cisplatin, and gemcitabine).

Main Results:

• In Assiut, 90% of patients achieved disease-free status post-cystoscopic reevaluation. However, local recurrence was observed in 74% of complete responders within 18 months.
• Sohag study reported recurrence-free survival of 84% at 17 months and 70% at 30 months. Overall survival was 95% at 17 months and 84% at 30 months.
• Assiut study showed disease-free survival of 66.7% and overall survival of 76.7%.

Conclusions:

• Significant prognostic factors for overall survival in Assiut included performance status, tumor size, and residual tumor.
• Tumor size and residual tumor were significant for disease-free survival in Assiut.
• Completeness of TUR and early tumor stage were identified as crucial for treatment response, consistent with findings from both studies.