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Abstract
Radical cystectomy with urinary diversion, in medically fit patients, is the standard of care for muscle-invasive bladder cancer in many institutions. Surgery results is only 40% to 60% 5-year overall survival, and despite a high local control attained by this approach, still 20% to 30% of patients may develop local relapse with or without metastatic spread.
Conservative management with organ preservation in patients who could otherwise undergo radical surgical extirpation is now the standard of care in numerous malignancies, where radical surgery can be avoided in many patients without compromising survival.
In muscle-invasive bladder cancer, bladder sparing therapy has been developed with the aim of cure in addition to the preservation of a normal functioning bladder. The survival results from bladder preservation compare favorably to radical cystectomy.
The present study aimed to assess the local control survival and toxicity in patients with muscle-invasive bladder cancer treated by TURBT followed by chemoradiation as a conservative management of bladder cancer, and also to investigate whether modifying the technique to include the whole bladder only rather than whole pelvis followed by bladder boost can reduce the toxicity of radiation without impacting on pelvic control.
This study included 63 patients with histologically proven transitional cell carcinoma of the bladder (muscle-invasive stage T2 and T3), with no clinical regional or distant metastases.
All patients were subjected to full history taking, thorough clinical examination and investigations. Patients were divided into two treatment groups:
– Group I (thirty-two patients) allocated to receive whole pelvis radiotherapy to 44 Gy, followed by 20 Gy boost to the bladder.
– Group II (thirty-one patients) allocated to receive whole bladder radiotherapy to 64 Gy.
In both groups, concomitant cisplatin and paclitaxel were given weekly throughout the whole course of radiotherapy. After the end of chemoradiotherapy, four cycles of adjuvant cisplatin and paclitaxel were given.
Both groups were comparable as regard the clinico-pathological features of the patients.
In both groups, patients were subjected to maximal transurethral resection of the bladder tumor (TURBT), as much as possible. However, only 81% of patients in the whole study had their tumors completely resected visibly as judged by the urologist. Complete TURBT was done in 78.1% of patients in group I and 83.9% of patients in group II.