ABSTRACT
This study was conducted to evaluate the efficacy of transurethral resection plus chemo radiation in achieving bladder preservation, using conformal radiotherapy and twice weekly Gemcitabine. Thirty seven TCC patients with good performance status, and maximum possible transuretheral resection .They received. 46 GY/23 fractions with twice weekly Gemcitabine 30mg/m2. An evaluation was done after 2 weeks by cystoscopy and biopsy from the tumor bed. Patients who had a complete response continued in phase II, 20 GY/2 weeks, with twice weekly Gemcitabine 30 mg/m2. Patients who had invasive bladder cancer were subjected to radical cvsteclomy. Thirty two patients had complete response. Treatment schedule was tolerable. It was associated with moderate toxicity that was tolerable apart of patients who developed G3 wxicity [hat required treatment interruption till improvement .After 2 years of follow up, 29 patients achieved good local control and the 2 years LRFS was 79%. The 2 years over al survival and bladder intact survival was 70%, 69%, respectively. Trimodality bladder-sparing approach consists of inmsureihral resection, chemotherapy twice daily using gemcitabine and radiotherapy is well tolerated with high rate of bladder preservation. This approach can be considered a reasonable alternative to cystectomy in the proper selected group