Long-term Results of Two Prospective Bladder-sparing Trimodality Approaches for Invasive Bladder Cancer: Neoadjuvant Chemotherapy and Concurrent Radio-chemotherapy

• Published in: Urology (Ridgewood, N.J.) N.J.), 2012-11, Vol.80 (5), p.1056-1062
• Main Authors: Zapatero, Almudena, Martin De Vidales, Carmen, Arellano, Ramon, Ibañez, Yamile, Bocardo, Gloria, Perez, Mar, Rabadan, Mariano, García Vicente, Feliciano, Cruz Conde, Jose A, Olivier, Carlos
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Biopsy; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - therapy; Combined Modality Therapy; Cystectomy - methods; Cystoscopy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Nephrology. Urinary tract diseases; Prospective Studies; Radiotherapy, Adjuvant; Spain - epidemiology; Survival Rate - trends; Time Factors; Treatment Outcome; Tumors of the urinary system; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.07.045

Objective To report long-term outcomes of selective organ preservation for muscle-invasive bladder cancer (MIBC) using 2 bladder-sparing trimodality approaches. Materials And Methods From 1990 to 2010, 80 patients with T2-T4 bladder cancer were prospectively enrolled in 2 successive bladder-sparing protocols. Forty-one patients were treated with neoadjuvant methotrexate, cisplatin, and vinblastine (MCV) chemotherapy followed by radiotherapy (60 Gy) in complete responders (protocol 1 [P1]) and 39 patients were treated with weekly cisplatin concurrent with radiotherapy (64.8 Gy) (protocol 2 [P2]). Results The median follow-up was 72 months (range, 9-204 months). Five and 10-year cumulative overall survival for all series were 73% and 60% and the corresponding numbers for cancer-specific survival were 82% and 80%, respectively. Of all surviving patients, 83% maintained their own bladder. Although there were no significant differences in overall survival ( P = .820), cancer-specific survival ( P = .688) and distant metastasis ( P = .417) between protocols, complete response rates ( P = .003), and disease-free survival ( P = .031) were significantly higher in P2 treatment. Conclusion Trimodality therapy with bladder preservation represents a real alternative to radical cystectomy (RC) in selected patients. Overall survival and cancer-specific survival rates are encouraging with more than 80% of survivors retaining functional bladders.