BLADDER PRESERVATION BY COMBINED-MODALITY THERAPY FOR INVASIVE BLADDER-CANCER

Purpose: To update the efficacy of a selective multimodality bladder-p reserving approach by transurethral resection (TURBT), systemic chemot herapy, and radiation therapy. Patients and Methods: From 1986 through 1993, 106 invading clinical stage T2 to T4a,Nx,MO bladder cancer were treated with induction by maximal TURBT and two cycles of chemotherap y (methotrexate, cisplatin, vinblastine [MCV]) followed by 39.6-Gy pel vic irradiation with concomitant cisplatin. Patients with a negative p ostinduction therapy tumor site biopsy and cytology (a T0 response, 70 patients) plus those with less than a T0 response but medically unfit for cystectomy (six patients), received consolidative chemoradiation to a total of 64.8 Gy. Surgical candidates with less than ct T0 respon se (13 patients) and patients who could not tolerate the chemoradiatio n (six patients) went to immediate cystectomy. The median follow-up du ration is 4.4 years. Results: The 5-year actuarial overall survival an d disease-specific survival rates of all patients are 52% and 60%, res pectively. For clinical stage T2 patients, the actuarial overall survi val rate is 63%, and for T3-4, 45%. Thirty-six patients (34%) underwen t cystectomy, all with evidence of tumor activity, including 17 with a n invasive recurrence. The 5-year overall survival rate with an intact functioning bladder is 43%. Among 76 patients who completed bladder-p reserving therapy, the 5-year rate of freedom from an invasive bladder relapse is 79%. No patient required cystectomy for treatment-related bladder morbidity. Conclusion: Combined modality therapy with TURBT, c hemotherapy, radiation, and selection for organ-conservation by respon se has a 52% overall survival rate. This result is similar to cystecto my-based studies for patients of similar age and clinical stages. The majority of the long-term survivors retain fully functional bladders. (C) 1997 by American Society of Clinical Oncology.