ABSTRACT
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