Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer

Authors

  • Emmanuelle Fabiano Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Catherine Durdux Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Bertrand Dufour Department of Urology, Necker Hospital, University of Paris Descartes, Paris, France
  • Arnaud Mejean Department of Urology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Nicolas Thiounn Department of Urology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Yves Chrétien Department of Urology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Jean-Emmanuel Bibault Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Philippe Giraud Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Sarah Kreps Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Antoine Smulevici Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Safia Maraadji Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France
  • Martin Housset Department of Radiation Oncology, European Hospital Georges Pompidou, University of Paris Descartes, Paris, France

DOI:

https://doi.org/10.1080/0284186X.2021.1915498

Keywords:

Bladder cancer, trimodal treatment, organ sparing treatment, radiotherapy, outcome assessment

Abstract

Purpose

To evaluate trimodal conservative treatment as an alternative to radical surgery for urothelial muscle-invasive bladder cancer (MIBC).

Patients and methods

This retrospective study reported the carcinologic and functional results of patients (pts) presenting a cT2/T3 N0M0 operable MIBC and fit for surgery, treated by a conservative strategy. Treatment consisted of a transurethral resection (TURB) followed by concomitant bi-fractionated split-course radiochemotherapy (RCT) with 5FU-Cisplatine. A control cystoscopy was performed six weeks after the induction RCT (eq45Gy) with systematic biopsies. Patients with complete histologic response achieved RCT protocol. Salvage surgery was proposed to pts with persistent tumor.

Results

313 pts (83% cT2 and 17% cT3) treated between 1988 and 2013 were included, with a median follow-up of 59 months and 67-year mean age. After the induction RCT, the histologic response rate was 83%. After five years, overall, disease-free, and functional bladder-intact survival rates were respectively 69%, 61%, and 69%, significantly better for pts in complete response after induction RCT. Late urinary and digestive toxicities were limited, with respective rates of 4% and 1.5% of grade 3 toxicity.

Conclusion

Trimodal strategy with RCT after TURB showed interesting functional and oncologic results and should be considered as an alternative to surgery in well-selected pts.

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Published

2021-06-03

How to Cite

Fabiano, E., Durdux, C., Dufour, B., Mejean, A., Thiounn, N., Chrétien, Y., … Housset, M. (2021). Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer. Acta Oncologica, 60(6), 794–802. https://doi.org/10.1080/0284186X.2021.1915498

Issue

Vol. 60 No. 6 (2021): Acta Oncologica

Section

Articles