SELECTIVE BLADDER PRESERVATION BY COMBINATION TREATMENT OF INVASIVE BLADDER-CANCER

Background. For patients with invasive bladder cancer the usual recomm ended treatment is radical cystectomy, although transurethral resectio n of the tumor, systemic chemotherapy, and radiotherapy are each effec tive in some patients. We sought to determine whether these treatments in combination might be as effective as radical cystectomy and thus m ight allow the bladder to be preserved and the cancer cured. Methods. We enrolled 53 consecutive patients with muscle-invading bladder cance r (stages T2 through T4, NXMO) in a trial of transurethral surgery, co mbination chemotherapy, and irradiation (4000 cGy) with concurrent cis platin administration. Urologic evaluation of the tumor response direc ted further therapy: radical cystectomy in the 8 patients who had inco mplete responses, additional chemotherapy and radiotherapy (6480 cGy) in the 34 patients who had complete responses or who were unsuited for cystectomy, and alternative care in the 11 patients who could not tol erate either irradiation or chemotherapy. Results. After a median foll ow-up of 48 months, 24 of the 53 patients (45 percent) were alive and free of detectable tumor. In 31 patients (58 percent) the bladder was free of invasive tumor and functioning well, even though in 9 (17 perc ent) a superficial tumor recurred and required further transurethral s urgery and intravesical drug therapy. Of the 28 patients who had compl ete responses after initial treatment, 89 percent had functioning tumo r-free bladders. Conclusions. Conservative combination treatment may b e an acceptable alternative to immediate cystectomy in selected patien ts with bladder cancer, although a randomized clinical trial that incl uded a group for simultaneous comparison would be required to produce definitive results.