Introduction

Over the last decades, several studies, including our group have shown that the use of tri-modal therapy consisting of transurethral bladder resection followed by concomitant chemotherapy and radiation therapy results in comparable outcomes to radical cystectomy, considered the gold standard for muscle invasive bladder cancer (MIBC). We present our oncologic outcomes for tetra-modal bladder preservation technique, which include tri-modal therapy followed by selective intra-arterial infusion of chemotherapeutics.

Methods

We performed an analysis of our prospectively maintained IRB approved database of multimodal bladder preservation technique. Our tetra-modality therapy consisted of complete resection of the tumor, chemotherapy and radiation therapy followed by dual balloon occluded intra-arterial infusion of chemotherapeutics - OMC regimen. We included all cases from August 2009 until December 2015 with at least 6 months of follow up. We evaluated oncologic outcomes based on T-stage, grade, lymph node status, age, sex, and presence of hydronephrosis. All data was analyzed using SPSS ver15.

Results

Four-hundred ten MIBC patients were enrolled in the study (median age 67 years, 78.8% male, ECOG performance status 0/1/2 100.0%, T-stage II/III/IV 67.1%;23.1%; 9.8%). The mean 8-year OS was 75.1 months (95% CI; 70.5-79.7) for cT II versus 77.1 months (95% CI; 67.7-86.5) for cT III, and 41.8 months (31.7-52.0) for cT IV. Univariate analysis for 8-year OS showed that patients&[prime] deaths were associated with age (p = 0.036) T-stage (p < 0.001), positive node (p = 0.002), and presence of hydronephrosis (p < 0.001). On multivariable logistic regression analysis adjusted for gender, age, T-stage, positive node, hydronephrosis, and tumor grade, age (p=0.006, HR:1.04, 95%CI: 1.01-1.07), T-stage (p=0.002, HR:1.80, 95%CI: 1.25-2.95), N-stage (p=0.010, HR:1.36, 95%CI: 1.08-1.73), and presence of hydronephrosis (p=0.012, HR:2.28, 95%CI: 1.20-4.35) remained as predictors for worse prognosis.

Conclusions

Our tetra-modality OMC-regimen significantly improves the chance of bladder preservation. Carefully selected cT II/ III patients without hydronephrosis are good candidates for bladder preservation.

Funding

none