Chemoradiation for organ preservation in the treatment of muscle invasive bladder cancer: Our Institutional Experience.

AIM: To assess outcome of chemoradiotherapy for organ preservation in muscle invasive bladder cancer.

MATERIAL AND

METHODS

41 patients treated between January 2010 to January 2015 were evaluated in the present study. All patients T staged ranging from cT2-T4a and had undergone maximal transurethral resection of bladder tumour (TURBT). After maximum bladder tumour resection patients were treated with Radiotherapy with or without concurrent chemotherapy. 8 weeks after completion of treatment response was assessed by check cystoscopy, urine cytology and CECT scan Abdomen. Data regarding the toxicity profile, initial complete response rates at 3 months, occurrence of loco regional or distant failure and survival was recorded.

RESULTS

Age ranged between 45- 84 years, (mean age 65.44). Radiotherapy dose planned ranged from 60 Gy/30fr to 70.3 Gy/37 fractions to primary target and 59.2 Gy/37fractions to the nodal disease. PTV volume ranged from 69-548.9 cc. 23 patients received concurrent chemotherapy weekly. 11 patients have cystitis (5 Gr 1, 4 Gr II and 2 Gr III). 5 patients have myelosuppression. 10 patients have acute gastrointestinal toxicity (5 Gr-I, 4 Gr-II, 1 Gr-III). At the time of analysis follow up ranged from 3-42 months (median follow 1 year).The DFS at 42 months was 54%. Out of 39 patients 3 were lost to follow up (2 in partial bladder group and 1 in whole bladder group). Out of 36 patients 24 (66.6%) are disease free, 4 (11.1%) patients had recurrence for which 2 underwent salvage cystectomy whereas 2 patients received palliative chemotherapy. Five patients developed distant metastases (4 bone and 1 brain metastasis).

CONCLUSION

Bladder-preservation therapy for muscle-invasive bladder cancer is a valid substitute in selected cases with long-term efficacy similar to radical cystectomy, with the additional advantage of preserving excellent bladder function in the majority of long-term survivors.