Bladder preservation in muscle invasive bladder cancer

Twenty eight patients with muscle invasive transitional cell carcinoma of the bladder (stage T2-T4NOMO) were treated with bladder sparing protocols after initial transurethral resection (TUR) of bladder tumor. The trial consisted of initial radiotherapy (6480cGy) with 2 courses of cisplatin plus additional 2 courses of MCV chemotherapy. The distribution of patients were cT2 in 10, cT3 in 15, and cT4 in 3 patients. All patients were pathologically proven as having muscle invasive bladder cancer. If there was no visible protruding mass in the bladder after TUR, it was regarded as a complete resection state. Repeat TUR or deep biopsy was conducted on the basis of cystoscopic findings with an interval of 3 months after initiation of therapy. We recommended radical cystectomy in patients with persistent or newly developed tumor. With a mean follow up of 44.1 months (10 to 64 months), the disease free survival rate was 60.7% (17/28) including four cystectomy cases - 90% (9/10) in cT2, 53.3% (8/15) in cT3 and none in cT4. Two year survival rate was 90.9% (20/22) and three year 59.3% (11/17). Local tumor recurrence or distatnt metastasis was observed in 11 patients. Side reactions such as neutropenia was observed in 10 (35.7%) patients, radiation cystitis orproctitis in 4 (14.2%). The response was closely related with the initial stage at presentation and tumor grade. Extensive TUR is strongly recommended to achieve the maximal therapeutic effect. Our data demonstrates that bladder preservation trial in locally advanced bladder cancer has relatively satisfactory results although longer follow up is required to determine the efficacy of current protocol in long term survival and quality of life.