Cancer Research Lab

A bladder sparing protocol is feasible in a selected population of patients with muscle-invasive bladder cancer who decline radical surgery, Italian researchers report in the January issue of Cancer.

“Our findings support the safety and effectiveness of multimodality treatment,” senior investigator Dr. Ricardo Autorino said. “We found complete response, bladder-intact survival and overall survival rates to be similar to those determined in previously published series.”

Dr. Autorino and colleagues at the Second University of Naples studied 121 patients with T2, T3 or T4 bladder cancer. Their mean age was 63 years. None had hydronephrosis or significant comorbidities.

The patients underwent transurethral resection of the tumor, received 2 cycles of neoadjuvant chemotherapy and then radiotherapy or radiochemotherapy.

Six weeks later, 102 of the 119 evaluable patients (85.7%) achieved a complete response. At a median follow-up of 5.5 years, 67 (65.7%) showed no local or distant disease recurrence. A further 17 (16.7%) had superficial local recurrence and 18 (17.6%) had muscle-invasive relapse.

The tumor-specific 5-year survival rate was 73.5%. Corresponding proportions for overall and bladder-intact survival were 67.7% and 51.2%.

The treatment was effective, but Dr. Autorino pointed out that “multimodality bladder-preserving strategies are complex, requiring, apart from high patient compliance, close cooperation among several clinical specialties.”

“Therefore, bladder preservation is feasible, even if it necessitates an extremely cautious approach,” he concluded.