Clinical experience with radiotherapy alone and radiochemotherapy with platin based regimens in organ-sparing treatment of invasive bladder cancer

الملخص EN

Purpose : to evaluate experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival Patients and Methods: Between January 1998 and January 2007, 186 patients with muscle invasive transitional cell carcinoma (TCC) of the urinary bladder were treated with radiotherapy (RT ; n = 72), or radio chemotherapy (RCT ; n = 114) with plating based regimens after transurethral resection (TUR) of the tumor.

About 3 to 4 weeks after RT / RCT, response was evaluated by restaging-TUR.

In case of complete response (CR), patients were observed at regular intervals.

In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended.

Median follow-up was 58.8 months (range, 3.1 to 100.4 Months).

Results : complete response was achieved in 72.6 % of patients.

Local control after CR without any relapse was maintained in 70.9 % of patients at 5 years.

Distant metastases were diagnosed in 50 patients with an actuarial rate of 28.23 % at 5 years.

Five-year overall survival (OAS) was 64.82% for the whole group of patients, and it was 67.14 % for cases who preserved their bladder.

Early tumor stage, age < 60 years, low tumor grade, absence of pelvic lymph nodes, and a complete TUR were the most important significant factors predicting CR and survival.

RCT was more significantly effective than RT alone in development of CR.

Salvage cystectomy was associated with a 4.55 % disease-free survival rate and 30.78 % overall survival rate at 5 years.

Conclusion : Transurethral resection with radio chemotherapy are reasonable option for patients seeking an alternative to radical cystectomy.

Ideal candidates are those with early-stage, age < 60 years, low tumor grade, and absence of pelvic lymph nodes ; in whom a complete TUR is accomplished.