BLADDER-SPARING MULTIMODALITY TREATMENT OF MUSCLE-INVASIVE BLADDER-CANCER - A 5-YEAR FOLLOW-UP

Objectives. To determine the long-term results of a bladder-sparing ap proach in the treatment of muscle-invasive bladder cancer. Methods. Ni nety-four patients with invasive transitional cell carcinoma of the bl adder were treated by transurethral resection followed by 2 or 3 cycle s of cisplatin-based chemotherapy. Patients were then treated with 648 0 cGy of radiation in 49 patients, segmental cystectomy in 8, or surve illance only in 7. Patients who failed to respond to chemotherapy or r adiation therapy, or who developed recurrent muscle-invasive disease i n follow-up, underwent salvage cystectomy. Patients were then carefull y followed for a median follow-up of more than 5 years. Results. After initial therapy, 53 patients (56%) were alive with their bladder pres erved. Thirty of those 53 (57%) developed a local recurrence in follow -up. After a median follow-up of more than 5 years, the ultimate relap se-free survival is 49% (Stage T2, 84%; T3, 53%; and T4, 11%; P < 0.01 ). Of all patients enrolled, 53% had bladder preservation; however, of the currently surviving patients, 16 of 39 (41%) have their bladders intact (T2, 50%; T3, 37%; T4, 0%). Only 18% of the initially enrolled population is alive with a preserved bladder. The 5-year survival of p atients who had cystectomy at some point during the study, compared wi th those who have had their bladders preserved, was 65% versus 40%, re spectively (P < 0.01). Conclusions. Our long-term results with multimo dality therapy with attempted bladder preservation showed no definitiv e improvement in survival compared with modern series of cystectomy al one, and a disappointingly low rate of disease-free bladder preservati on. We found a high rate of locally recurrent disease in the preserved bladders. We also noted a decrease in survival in our patients with b ladder preservation compared with those without preservation. Bladder preservation, although possible, should be limited to a very select gr oup of patients.