Bladder preservation by combined modality therapy for invasive bladder cancer

Area of Science:

• Urology
• Oncology
• Radiation Oncology

Background:

• Muscle-invading bladder cancer (MIBC) poses significant treatment challenges.
• Radical cystectomy is the standard treatment, but associated with morbidity.
• Bladder-preserving strategies aim to improve quality of life while maintaining oncologic control.

Purpose of the Study:

• To evaluate the long-term efficacy of a bladder-preserving approach for MIBC.
• To assess overall survival, disease-specific survival, and bladder preservation rates.
• To update findings on a multimodality treatment combining transurethral resection, chemotherapy, and radiation.

Main Methods:

• 106 patients with clinical stage T2-T4a MIBC were treated with transurethral resection (TURBT), chemotherapy (MCV), and pelvic radiation.
• Patients achieving a complete response (T0) or medically unfit for cystectomy received consolidative chemoradiation.
• Patients not achieving T0 response or intolerant to chemoradiation underwent cystectomy.

Main Results:

• The 5-year overall survival rate was 52% and disease-specific survival was 60%.
• For clinical stage T2 patients, 5-year overall survival was 63%; for T3-4, it was 45%.
• Among 76 patients completing bladder-preserving therapy, 79% were free from invasive bladder relapse at 5 years, with 43% overall survival with an intact bladder.

Conclusions:

• Combined modality therapy with TURBT, chemotherapy, and radiation offers comparable survival to cystectomy for selected MIBC patients.
• This bladder-preserving approach allows a majority of long-term survivors to retain a functional bladder.
• Organ-conservation by response selection is a viable strategy for managing MIBC.