Bladder Preservation Strategies for Treatment of Muscle-Invasive Bladder Cancer: Experience of 7-Year Follow up

Lee, Deok Yong; Chung, Byung Ha; Hong, Sung Joon

Abstract

PURPOSE: Currently, the initial treatments of muscle-invasive bladder cancer can be divided into bladder preservation strategies and radical cystectomy. We report our long-term clinical experience of multimodality therapy, using bladder preservation strategies, in patients with muscle-invasive bladder cancer.
MATERIALS AND METHODS
Between 1991 and 1994, 23 patients, with a muscle-invasive transitional cell carcinoma of the bladder, underwent a rigorous transurethral resection of the bladder tumor, followed by concurrent cisplatin containing chemotherapy and radiotherapy. The patients' response to the treatment was evaluated with cystoscopy, urine cytology, chest radiography, abdominal-pelvic CT and whole body bone scans following completion of the treatment. Prognostic factors, such as T stage, tumor shape, tumor grade, and initial tumor resection status, were analyzed and the overall 5-year survival rate and disease-specific 5-year survival rate estimated.
RESULTS
Of the 23 patients, 3 required a radical cystectomy due to a tumor recurrence. The T stage and initial tumor resection status seemed to be the most significant prognostic factors. The overall 5-year survival rate and disease-specific 5-year survival rate were 64 and 71% (stage T2, 62% and 83%; stage T3, 64% and 63%; stage T4: 0%), respectively, and the rate for retaining a functional bladder was 50%.
CONCLUSIONS
Our actuarial 5-year overall and disease-specific survival rates were comparable with those reported for a contemporary radical cystectomy, and with other studies on multimodality bladder sparing treatments for patients at similar clinical and pathological stages. Multimodality treatment, with bladder preservation, can be regarded as an efficacious treatment, with most long-term survivors retaining functional bladders.