BLADDER SPARING TREATMENT FOR MUSCLE-INVASIVE BLADDER CANCERS

Czech version

Authors: Boris Eliáš; Roman Tomaškin; Ján Kliment, ml.; Ján Šulgan; Ján Kliment
Authors‘ workplace: Urologická klinika, Jesseniová lekárska fakulta Univerzity Komenského a Martinska fakultná nemocnica, Martin
Published in: Ces Urol 2016; 20(4): 309-316
Category: Original Articles

Overview

Objectives:
The aim of this study was to evaluate treatment outcomes of muscle-invasive bladder cancers treated with radical TURB followed by adjuvant chemotherapy, radiotherapy, or their combination in order to preserve functional bladder.

Material and methods:
We retrospectively evaluated patients with muscle-invasive urothelial tumors who were treated at the Department of Urology in Martin from 2005–2016 by radical TURB followed by adjuvant therapy. If histological examination confirmed invasive urothelial carcinoma (pT2a-pT2b) all such patients underwent re-TURB. In the analysis were included only patients who had negative histology (pT0) after re-TURB, the primary solitary tumor was ≤3 cm in size, ureterohydronephrosis was not present, not the presence of diffuse CIS and there was no tumor invaded outside the bladder wall. Thereafter, patients were treated with adjuvant chemotherapy, radiotherapy or their combination. Statistically, we evaluated baseline characteristics of the patients, adjuvant therapy, recurrence rate and overall survival.

Results:
The cohort of 14 patients aged 54–69 years (mean 61 years) consisted of 7 women and 7 men. All of the patients after radical TUR-B had confirmed invasive urothelial carcinoma pT2a-pT2b, G2-G3 After re-TURB no patient had residual tumor from the base (pT0), one patient had CT verified enlargement of obturator LN up to 3 cm. Adjuvant chemotherapy as a monotherapy underwent 6 (42 %) patients, 7 (50 %) underwent concomitant chemoradiotherapy and 1 (8 %) patient refused any treatment. Local recurrence of muscle-invasive bladder tumor was not present in none of the patients, 1 (8 %) patient surgically removed obturator LN (confirmed metastasis) after two years, 3 (21 %) patients had a recurrence of a non-invasive high-grade urothelial carcinoma pT1, G3. 13 (92 %) patients are surviving 1–11 years (median 6 years), no patient has died because of disease progression, 1 (8 %) patient died due to MI.

Conclusion:
The results of our limited study suggest, that in well- selected patients with muscle invasive transitional cell bladder cancers (pT0 after re-TURB) after trimodal therapy we can achieve complete response with minimal risk of local or systemic progression and long-term cancer specific- free survival. It requires multidisciplinary collaboration of urologist, radiation oncologist and medical oncologist as well as close cooperation of patients who require regular long-term cystoscopic and CT / MR surveillance because of a risk of local or systemic recurrence.

Key words:
Muscle-invasive bladder cancers, TURB, chemoradiotherapy, trimodality therapy, bladder sparing, bladder preservation.

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