PURPOSE: To evaluate experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival. PATIENTS AND METHODS: Between January 1998 and January 2007, 186 patients with muscle invasive transitional- cell carcinoma (TCC) of the urinary bladder were treated with radiotherapy (RT; n=72), or radiochemotherapy (RCT; n=114) with platin based regimens after transurethral resection (TUR) of the tumor. About 3 to 4 weeks after RT/RCT, response was evaluated by restaging-TUR. In case of complete response (CR), patients were observed at regular intervals. In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended. Median follow-up was 58.8 months (range, 3.1 to 100.4 months). RESULTS: Complete response was achieved in 72.6% of patients. Local control after CR without any relapse was maintained in 70.9% of patients at 5 years. Distant metastases were diagnosed in 50 patients with an actuarial rate of 28.23% at 5 years. Five-year overall survival (OAS) was 64.82% for the whole group of patients, and it was 67.14% for cases who preserved their bladder. Early tumor stage, age <60 years, low tumor grade, absence of pelvic lymph nodes, and a complete TUR were the most important significant factors predicting CR and survival. RCT was more significantly effective than RT alone in development of CR. Salvage cystectomy was associated with a 4.55% disease-free survival rate and 30.78% overall survival rate at 5 years. CONCLUSIONS: Transurethral resection with radiochemotherapy are reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage, age <60 years, low tumor grade, and absence of pelvic lymph nodes; in whom a complete TUR is accomplished. KEY WORDS: Bladder cancer - Muscle invasive - Radiochemotherapy - Radiotherapy.
PURPOSE: To evaluate experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival. PATIENTS AND METHODS: Between January 1998 and January 2007, 186 patients with muscle invasive transitional- cell carcinoma (TCC) of the urinary bladder were treated with radiotherapy (RT; n=72), or radiochemotherapy (RCT; n=114) with platin based regimens after transurethral resection (TUR) of the tumor. About 3 to 4 weeks after RT/RCT, response was evaluated by restaging-TUR. In case of complete response (CR), patients were observed at regular intervals. In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended. Median follow-up was 58.8 months (range, 3.1 to 100.4 months). RESULTS: Complete response was achieved in 72.6% of patients. Local control after CR without any relapse was maintained in 70.9% of patients at 5 years. Distant metastases were diagnosed in 50 patients with an actuarial rate of 28.23% at 5 years. Five-year overall survival (OAS) was 64.82% for the whole group of patients, and it was 67.14% for cases who preserved their bladder. Early tumor stage, age <60 years, low tumor grade, absence of pelvic lymph nodes, and a complete TUR were the most important significant factors predicting CR and survival. RCT was more significantly effective than RT alone in development of CR. Salvage cystectomy was associated with a 4.55% disease-free survival rate and 30.78% overall survival rate at 5 years. CONCLUSIONS: Transurethral resection with radiochemotherapy are reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage, age <60 years, low tumor grade, and absence of pelvic lymph nodes; in whom a complete TUR is accomplished. KEY WORDS: Bladder cancer - Muscle invasive - Radiochemotherapy - Radiotherapy.