The first and second authors contributed equally to this article.
Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer†
A multi-institutional, long-term experience
Article first published online: 15 NOV 2007
Copyright © 2007 American Cancer Society
Volume 112, Issue 1, pages 75–83, 1 January 2008
How to Cite
Perdonà, S., Autorino, R., Damiano, R., De Sio, M., Morrica, B., Gallo, L., Silvestro, G., Farella, A., De Placido, S. and Di Lorenzo, G. (2008), Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer. Cancer, 112: 75–83. doi: 10.1002/cncr.23137
Presented in part at the 22nd Annual Meeting of the European Association of Urology, Berlin, Germany, March 21–24, 2007.
- Issue published online: 17 DEC 2007
- Article first published online: 15 NOV 2007
- Manuscript Accepted: 24 JUL 2007
- Manuscript Revised: 18 JUL 2007
- Manuscript Received: 9 MAY 2007
- bladder cancer;
- conservative treatment;
- transurethral resection
The authors evaluated their long-term experience with combined-modality, conservative treatment in patients with muscle-invasive bladder cancer.
In total, 121 patients with T2, T3, or T4 bladder cancer (mean age, 63 years; ratio of men to women, 3:1) underwent induction by transurethral resection (TUR) of the tumor and received 2 cycles of neoadjuvant chemotherapy followed by radiotherapy (RT) (n = 43 patients) or radiochemotherapy (RCT) (n = 78 patients). Six weeks after RT or RCT, responses were evaluated by restaging TUR. Patients who achieved a complete response (CR) were observed at regular intervals. In patients who had persistent or recurrent invasive tumor, further treatment was recommended.
Local response evaluation by restaging TUR was possible in 119 patients, and 102 of those patients (85.7%) achieved a CR. After a median follow-up of 66 months (range, 6–182 months), no local or distant disease recurrences were observed in 67 of 102 complete responders (65.7%), 17 of 102 complete responders (16.7%) experienced superficial local disease recurrence, and 18 of 102 complete responders (17.6%) had a muscle-invasive relapse. The 5-year tumor-specific, overall, and bladder-intact survival rates were 73.5%, 67.7%, and 51.2%, respectively. Treatment modality, tumor classification, and resection status after initial TUR had an impact on survival rates (P = .04, P = .02, and P = .02, respectively).
The current results indicated that conservative combined treatment is a reasonable alternative to radical cystectomy in selected patients with muscle-invasive bladder cancer. Cancer 2008. © 2007 American Cancer Society.