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  • Title: Long-term results of two prospective bladder-sparing trimodality approaches for invasive bladder cancer: neoadjuvant chemotherapy and concurrent radio-chemotherapy.
    Author: Zapatero A, Martin De Vidales C, Arellano R, Ibañez Y, Bocardo G, Perez M, Rabadan M, García Vicente F, Cruz Conde JA, Olivier C.
    Journal: Urology; 2012 Nov; 80(5):1056-62. PubMed ID: 22999456.
    Abstract:
    OBJECTIVE: To report long-term outcomes of selective organ preservation for muscle-invasive bladder cancer (MIBC) using 2 bladder-sparing trimodality approaches. MATERIALS AND METHODS: From 1990 to 2010, 80 patients with T2-T4 bladder cancer were prospectively enrolled in 2 successive bladder-sparing protocols. Forty-one patients were treated with neoadjuvant methotrexate, cisplatin, and vinblastine (MCV) chemotherapy followed by radiotherapy (60 Gy) in complete responders (protocol 1 [P1]) and 39 patients were treated with weekly cisplatin concurrent with radiotherapy (64.8 Gy) (protocol 2 [P2]). RESULTS: The median follow-up was 72 months (range, 9-204 months). Five and 10-year cumulative overall survival for all series were 73% and 60% and the corresponding numbers for cancer-specific survival were 82% and 80%, respectively. Of all surviving patients, 83% maintained their own bladder. Although there were no significant differences in overall survival (P = .820), cancer-specific survival (P = .688) and distant metastasis (P = .417) between protocols, complete response rates (P = .003), and disease-free survival (P = .031) were significantly higher in P2 treatment. CONCLUSION: Trimodality therapy with bladder preservation represents a real alternative to radical cystectomy (RC) in selected patients. Overall survival and cancer-specific survival rates are encouraging with more than 80% of survivors retaining functional bladders.
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