Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience
Cancer Research Journal
Volume 7, Issue 1, March 2019, Pages: 1-7
Received: Dec. 7, 2018;
Accepted: Dec. 19, 2018;
Published: Jan. 24, 2019
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Eman Awad Abd Allah, Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
Fatma Mohamed Farouk Akl, Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
Seham Elsayed-Abd-Alkhalek, Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
Background & objective: Bladder preservation therapy (BPT) using a trimodality approach represents an alternative option to cystectomy inmuscle-invasive bladder cancer (MIBC) patients, also a treatment option in non-cystectomy candidates. The objective of this study was to evaluate BPT using a trimodality approach composed of maximum TURBT, neoadjuvant chemotherapy, followed by chemoradiotherapy, regarding the overall survival (OS), progression free survival (PFS), locoregional progression free survival (LPFS) and treatment toxicity. Patients & methods: This prospective study involved 47 patients with pathologically proven MIBC (T2-T4a N0M0). The study involved muscle invasive bladder cancer patients who refused or were not cystectomycandidates. Patients enrolled received neoadjuvant 3cycles of Gemcitabine/Cisplatin, each cycle was every 21 days. Gemcitabine at 1000mg/m2 on days 1&8 and cisplatin at 70mg/m2 on day1, followed by Concurrent chemordiotherapy with cisplatin weekly (40mg/m2). Radiation therapy included the whole bladder by 3D conformal planning to a dose of 64Gy/32Fxs. Results: Of the 47 patients, 25 (53.2%) patients expressed complete response (CR), while 22(46.8%) patients had incomplete response. The 4-year OS, PFS, and LPFS rates were 48%, 38%, and 42%, respectively. Acute genitourinary (GU) toxicity of Grade 1 and 2 occurs in 54% and 24%of patients, respectively, while acute gastrointestinal (GI) toxicity (colic &diarrhea) of Grade 1 and 2 occurs in 27.7% and 10.6 %of patients, respectively. Conclusion: For MIBC patients who are non-cystectomy candidates, or who are motivated to maintain their bladders, trimodality bladder preservation therapy (BPT) can be considered as an effective alternative to radical cystectomy.
Eman Awad Abd Allah,
Fatma Mohamed Farouk Akl,
Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience, Cancer Research Journal.
Vol. 7, No. 1,
2019, pp. 1-7.
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