To report long-term results on survival, toxicity and patterns of failure of three different organ-sparing strategies for patients with muscle invasive bladder cancer (MIBC).
This is a mono-institutional prospective analysis of three consecutive bladder-sparing protocols combining maximal trans-urethral resection of bladder tumour (mTURBT), radiotherapy (RT) and cisplatin-based chemotherapy (QT). Protocol 1 consisted on neoadjuvant MCV followed by endoscopic re-evaluation and consolidative RT 60 Gy in complete responders. Protocol 2 involved altered-fractionation RT 64.8 Gy and concurrent weekly cisplatin with re-evaluation after 40.8 Gy. Protocol 3 consisted on RT 64.8 Gy with concomitant weekly cisplatin. Non-responders underwent radical cystectomy (RC). Probabilities for overall survival (OS), cause-specific-survival (CSS) and metastasis-free-survival (MFS) were calculated using Kaplan-Meier product limited estimates. A Cox-regression multivariate analysis (MVA) was performed to detect potential risk factors for OS, CSS and MFS.
The 10-year bladder preservation rate was 79%. The 10-year OS, CSS and MFS rates were 43.2%, 76.3 % and 79.2%, respectively. There was no statistically significant difference in OS between the different treatment protocols. On MVA, mTURBT of the bladder and the complete response after induction therapy (CR) were independent correlates of improved OS and of MFS. The development of invasive bladder recurrence was independently associated with worse cause-specific survival and MFS.
Ten-year results indicate that bladder-sparing treatment is a successful approach for MIBC in selected patients. mTURBT of the bladder tumour and complete response after induction therapy remain the most relevant predictive factors.
Urology. 2018 Sep 25 [Epub ahead of print]
D Büchser, A Zapatero, J Rogado, M Talaya, C Martín de Vidales, R Arellano, G Bocardo, A Cruz Conde, L Pérez, M Murillo
Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain . Electronic address: ., Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain., Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain.