The role of combined method in organ-sparing treatment of muscle-invasive bladder cancer recurrences.

OBJECTIVE

To determine the local control and survival of patients with bladder cancer recurrences (BCR) treated by operative methods, external beam radiotherapy (EBRT) and adjuvant chemotherapy (ACT).

MATERIALS AND METHODS

We have treated 180 patients (114 men, median age 64.5 years, range 56-73) with documented transitional-cell non-metastasized BC recurrences: 90 T2N0M0 and 90 T3aN0M0. All patients received different operations (transurethral resection and partial cystectomies) and definitive EBRT (total dose varied from 50 to 64 Gy with a mean of 60.5 Gy, 5 days a week). In a second group of patients we performed 3 courses of 4-drug regimen ACT administered with EBRT. ACT consisting of cisplatin and adriamycin i.a. and methotrexate and vinblastin i.v. (M-VAC) was administered on the fourth week after radiation therapy.

RESULTS

The overall response rate was 87.2% (157 patients), including 98 complete responses and 59 partial responses. The complete response rates in patients with clinical stage T2 and T3a disease was 64.4 and 44.4%, respectively and it was slightly higher in patients with a non-papillary cancer than in those with a papillary one. The actuarial results at 3 years of disease-free rate after EBRT + ACT were: 61.2% for T2 (p < 0.04) and 49.1% for T3 (p < 0.07). The acute toxicity was mild: no hematological and renal toxicity over grade II, 14 (7.8%) cases of bowel or rectal reversible grade II toxicity and 12 (6.7%) cases of reversible grade III cystitis. ACT was discontinued in 4 (4.4%) cases due to acute gastrointestinal toxicity and in 3 (3.3%) more, due to poor patient compliance.

CONCLUSIONS

Four-drug ACT is feasible without major toxicity and offers a potentially curative and conservative treatment for patients with localized muscle-invasive BC (bladder cancer) recurrences. Bladder conservation therapy may be offered to selected patients with BC recurrences as an alternative option to radical cystectomy, and its use should be limited to teams of uro-oncologists, experienced in multi-modalty treatment.