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Invasive bladder cancer: our experience with bladder sparing approach
J Cervek1, T Cufer, B Zakotnik
1Institute of Oncology, Ljubljana, Slovenia.
Summary
This study shows a bladder-sparing treatment combining transurethral resection and chemoradiotherapy is safe for muscle-invasive bladder cancer. It suggests radical cystectomy may not be the best option for all non-responders.
Area of Science:
- Uro-oncology
- Medical oncology
- Radiation oncology
Background:
- Muscle-invasive bladder cancer (MIBC) presents therapeutic challenges, with radical cystectomy being the standard treatment.
- Evaluating bladder-sparing alternatives is crucial for improving patient outcomes and quality of life.
Purpose of the Study:
- To assess the efficacy and feasibility of a bladder-sparing treatment strategy for MIBC.
- The strategy involves transurethral resection (TUR) followed by sequential chemoradiotherapy.
Main Methods:
- 105 patients with biopsy-proven invasive bladder cancer underwent maximal TUR.
- Complete responders received sequential chemotherapy (methotrexate, cisplatinum, vinblastine) and radiotherapy.
- Non-responders were considered for cystectomy.
Main Results:
- 52% of patients achieved a complete response after TUR and chemotherapy.
- Among 75 patients selected for bladder preservation, 69% remained disease-free at the bladder after 42 months.
- Survival was significantly better in chemotherapy responders (79%) versus non-responders (35%).
Conclusions:
- A bladder-sparing approach is safe and effective for a significant proportion of MIBC patients.
- Radical cystectomy's role in non-responders warrants further investigation, as survival outcomes were similar to those receiving radiotherapy.