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RESEARCH PRODUCT

The fate of patients with locally advanced bladder cancer treated conservatively with neoadjuvant chemotherapy, extensive transurethral resection and radiotherapy: 10-year

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Purpose: The authors assessed the results of bladder preservation for infiltrating bladder cancer. The potential for neoadjuvant chemotherapy followed by extensive transurethral resection and radiation therapy was evaluated in 40 patients with T2-T4a G2-G3 bladder carcinoma. Materials and Methods: From 1983 to 1995, 40 patients with bladder cancer underwent bladder-sparing treatment, consisting of neoadjuvant chemotherapy, extensive transurethral resection, and radiation therapy. Most patients had T3G3 cancer. A deep transurethral resection biopsy was performed before and after chemotherapy, and an extensive transurethral resection was repeated at the end of radiation therapy. Thirty patients received cisplatin and methotrexate, and 10 also received vinblastine. The total dose of radiation therapy was 60-65 Gy. Recurrent superficial tumors were treated transurethrally. Radical cystectomy was considered for persistent or recurrent invasive disease. Results: A complete response occurred after chemotherapy in 19 patients (47.5%) and after transurethral resection and radiation therapy in eight patients (67.5%). Within 10 years, eight responding patients (30%) had local recurrences and three underwent cystectomy. Fourteen (35%) patients are alive, including 13 with no evidence of disease (mean survival, 65 months), five died of unrelated disease, and 21 (52.5%) died of distant métastases (mean survival, 28 months). Of the 21 patients, 14 had residual tumor after radiation therapy, three presented with distant métastases after vesical infiltrating recurrence, and four had distant métastases in the absence of local-regional recurrence. In 22 patients (55%), the bladder was salvaged. Patients with complete response to chemotherapy had a low risk for recurrent infiltrating tumors and métastases. Conclusions: Complete tumor control was maintained at 5 years in more than 50% of the patients treated conservatively. Bladder salvage is feasible in select patients.