RESUMO
Objective: To determine the efficacy of trimodality therapy in patients with muscle invasive carcinoma of the bladder with deranged renal profile
Study Design: Quasi-experimental study
Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi over 14 months, from Sep 2015 to Nov 2016
Patients and Methods: Forty patients [n=40] having histopathologically confirmed [urothelial] urinary bladder cancer, clinical stage II or III, aged 18 to 80 years, with Eastern Cooperative Oncology Group [ECOG] perfor-mance status ?2 and having deranged renal functions were included in this study. After maximal transurethral resection of bladder tumour [TURBT], they received 4 courses of chemotherapy with mitomycin and 5 fluorou-racil, followed by concurrent chemoradiation using same chemotherapy received 50 Grays in 20 fractions. Response was assessed using RECIST criteria
Results: Efficacy; defined in terms of complete and partial response, was observed in 85 percent [n=34] of patients. Treatment efficacy was better in males as compared to females [90.6 percent vs. 62.55: p<0.05]. Patients with better ECOG-PS [0-1] and early stage [2] responded well to treatment while response was almost same in different age groups, [p>0.05 in all cases]. Thirty-seven patients were able to complete the full study protocol, 2 had severe mucositis and hand-foot syndrome while one patient died after septicaemia
Conclusion: Trimodality treatment with TURBT, chemotherapy and chemo-radiation is a feasible option for bladder preservation in muscle invasive bladder cancer patients with compromised renal functions if we use 5-fluorouracil and mitomycin chemotherapy