Introduction

To evaluate the bladder preservation strategy used at our institution for muscle-invasive bladder cancer (MIBC) in patients undergoing chemoradiotherapy.

Methods

In 71 patients with MIBC, transurethral resection of the bladder tumor was performed before treatment to confirm pathological stage ?T2. Fifty patients received cisplatin-radiation (CDDP-R) therapy and 21 received gemcitabine plus cisplatin-radiation (GC-R) therapy. Extensive transurethral resection of bladder tumors was performed after chemoradiotherapy to evaluate the pathological response to treatment. We used propensity score-match analysis to compare the oncological outcomes of patients treated by chemoradiotherapy to those of patients treated by open radical cystectomy (ORC).

Results

The 2- and 5-year progression-free survival (PFS), bladder-intact survival (BIS), cancer-specific survival (CSS), and overall survival rates after treatment were 71.6% and 66.1%, 68.9% and 56.1%, 85.1% and 72.5%, and 83.3% and 66.6%, respectively. The complete response (CR) after chemoradiotherapy could be a good predictor of PFS, BIS, and CSS (OR = 0.31, p < 0.05; OR = 0.22, p < 0.01; OR = 0.11, p < 0.005, respectively) and clinical stage T2 could be a significant predictor of good BIS and CSS (OR = 0.28, p < 0.05 and, OR = 0.21, p < 0.05, respectively). The response to GC-R was significantly better than that to CDDP-R (CR: 81% vs. 29.4%), with tolerable adverse events. According to our propensity score-match analysis, the 2- and 5-year overall survival rates after chemoradiotherapy were 89.2 and 78.9%, respectively, and those after ORC were 82.3 and 69.6%, respectively, indicating comparable survival benefit of chemoradiotherapy to that of ORC.

Conclusions

Bladder preservation by chemoradiotherapy for MIBC is as effective as radical cystectomy. GC-R treatment might be more effective with better cancer control than CDDP-R.

Funding

none