INVASIVE BLADDER-CANCER - OUR EXPERIENCE WITH BLADDER SPARING APPROACH

Purpose: Muscle-invasive bladder cancer (MIBC) is a disease associated with several unresolved therapeutic questions. Radical cystectomy sti ll represents the most frequent treatment approach. The aim of our stu dy was to evaluate the effect and feasibility of bladder-sparing treat ment by transurethral resection (TUR) and sequential chemoradiotherapy in patients with biopsy-proven invasive bladder cancer. Methods and M aterials: After maximal TUR, 105 patients were treated with two to fou r cycles of methotrexate, cisplatinum, and vinblastine polychemotherap y. In complete responders, the treatment was continued by radiotherapy (50 Gy to the bladder and 40 Gy to the regional lymph nodes), whereas in nonresponders, cystectomy was performed when feasible. Results: Co mplete response after TUR and chemotherapy was achieved in 52% of pati ents. After a median follow-up of 42 months, 52 of 75 patients (69%) s elected for bladder preservation were without evidence of disease in t he bladder. Freedom from local failure in complete responders to chemo therapy was 80% [95% confidence interval (CI), 69-91%) at 4 years. The actuarial survival of the entire group was 58% (95% CI, 47-69%), wher eas the survival rate with the bladder intact was 45% (95% CI, 34-56%) at 4 years. Survival was significantly better in patients who respond ed to chemotherapy (79%) than in nonresponders (35%, p < 0.0001). Ther e was no significant difference in survival between nonresponders who underwent cystectomy and nonresponders who completed treatment with ra diotherapy (approximately 30% at 3 years). Conclusion: The present stu dy confirms that MIBC is a heterogeneous disease, and that in more tha n half of patients who are affected, a bladder-sparing approach is saf e. Our study has also demonstrated that in nonresponders, radical cyst ectomy as the treatment of choice is questionable. (C) 1998 Elsevier S cience Inc.