Changes of urinary bladder salvage preservation in muscle invading transitional cell carcinoma of urinary bladder by the use of neoadjuvant chemotherapy and radiation therapy

ABSTRACT

Based on the excellent results obtained with chemotherapy in patients with advanced transitional cell carcinoma of urinary bladder, neoadjuvant chemotherapy has been advancated t improve survival and in some cases to permit bladder conservation. Twenty nine patients with transitional cell carcinoma of urinary bladder were seen at EBGH, Jaddah Cancer, Jan 1991-1994. All patients had tumour of either T[2] or T[3] stage N[X]-N[2] MO. Patients were given 3 cycles of CMV chemotherapy with cisplatinum, methotroxate and vinblastine. Patients who attained complete are partial response were given radioation therapy. The clinical complete response rate after chemo-radiation therapy was 59% [17/29 patients]. The 2-year disease free survival rate for the complete respondent is 76% whereas for the complete responders goups a 25% 2-year survival is attained. Surgery by radical cystectomy was offered to non responders as well as to chemoradiation therapy failures. The 2-year disease free survival with preserved bladder is 41%. Complete responders after chemoradiation therapy stand a good change of disease control with bladder preservation. Radical cystectomy is the appropriate treatment if no complete response is attained after chemotherapy