Aim: To assess outcome of chemoradiotherapy for organ preservation in muscle invasive bladder cancer.
Material and methods: 41 patients treated between January 2010 to January 2015 were evaluated in the present study. All patients T staged ranging from cT2-T4a and had undergone maximal transurethral resection of bladder tumour (TURBT). After maximum bladder tumour resection patients were treated with Radiotherapy with or without concurrent chemotherapy. 8 weeks after completion of treatment response was assessed by check cystoscopy, urine cytology and CECT scan Abdomen. Data regarding the toxicity profile, initial complete response rates at 3 months, occurrence of loco regional or distant failure and survival was recorded.
Results: Age ranged between 45- 84 years, (mean age 65.44). Radiotherapy dose planned ranged from 60 Gy/30fr to 70.3 Gy/37 fractions to primary target and 59.2 Gy/37fractions to the nodal disease. PTV volume ranged from 69-548.9 cc. 23 patients received concurrent chemotherapy weekly. 11 patients have cystitis (5 Gr 1, 4 Gr II and 2 Gr III). 5 patients have myelosuppression. 10 patients have acute gastrointestinal toxicity (5 Gr-I, 4 Gr-II, 1 Gr-III). At the time of analysis follow up ranged from 3-42 months (median follow 1 year).The DFS at 42 months was 54%. Out of 39 patients 3 were lost to follow up (2 in partial bladder group and 1 in whole bladder group). Out of 36 patients 24 (66.6%) are disease free, 4 (11.1%) patients had recurrence for which 2 underwent salvage cystectomy whereas 2 patients received palliative chemotherapy. Five patients developed distant metastases (4 bone and 1 brain metastasis).
Conclusion: Bladder-preservation therapy for muscle-invasive bladder cancer is a valid substitute in selected cases with long-term efficacy similar to radical cystectomy, with the additional advantage of preserving excellent bladder function in the majority of long-term survivors.