Clinical features and optimal treatment of primary urethral carcinoma / 现代泌尿外科杂志

【Objective】 To explore the clinical features and treatment outcomes of female urethral carcinoma so as to improve the awareness and prognosis of this rare malignant disease. 【Methods】 Clinical data of 8 cases of female urethral carcinoma treated during Jan. 2012 to Dec.2022 at the Department of Urology of Peking University People’s Hospital were retrospectively analyzed. The patients underwent urodynamic tests, cystourethroscopy and pathological biopsy to confirm the diagnosis. Traditional radical surgery was performed in 5 cases, and radical surgery for lower urethral cancer with bladder preservation was performed in 3 cases. 【Results】 The patients aged 36 to 68 years, with a mean of 53.75 years. Urinary obstruction, lower urinary tract symptoms and urethral masses were common manifestations. Urodynamic tests indicated bladder outlet obstruction. After surgical treatment, radical surgery for lower urethral cancer with bladder preservation showed advantages over traditional radical surgery in terms of intraoperative bleeding, operation time and postoperative hospital stay. 【Conclusion】 Female primary urethral carcinoma is rare but invasive. Early diagnosis and radical surgery are crucial for improving the prognosis. Radical surgery for lower urethral cancer with bladder preservation has better treatment outcomes and postoperative quality of life compared to traditional radical surgery. For such patients, symptoms should be closely monitored and timely diagnosis and treatment should be performed.

Advances in the comprehensive treatment of muscle-invasive bladder cancer with preservation of the bladder / 中华泌尿外科杂志

Bladder cancer(BC) ranks the first of genitourinary tumor in China and is one of the most common urological malignancies, in which 25%-30% of patients were diagnosed with muscle-invasive bladder cancer. Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for treatment, which can effectively avoid tumor recurrence or distant metastasis as well as improve the prognosis of patients. However, some patients may not tolerate or refuse to undergo radical bladder surgery due to worry about high complication rate, high morbidity and poor postoperative quality of life. With the increasing understanding of bladder cancer heterogeneity and biological behavior, the treatment of bladder cancer has changed from a surgery-based treatment model to an individualized and comprehensive treatment model by multidisciplinary collaboration. The bladder-preserving treatment can achieve the same oncological prognosis as that of radical bladder surgery with a better quality of life of the patients, which has become a hot topic and focus of research in muscle-invasive bladder cancer treatment. This article reviewed the progress of research related to the comprehensive treatment of muscle-invasive bladder cancer with preservation of the bladder.

Totally intracorporeal robot-assisted orthotopic ileal neobladder after bladder preservation therapy: a case report / 中华泌尿外科杂志

The patient, a 56-year old male, was admitted to the hospital for recurrent bladder cancer in November 29, 2021. The patient had previously undergone partial cystectomy, simultaneous radio-chemotherapy to preserve the bladder, and repeated 4 times TURBt. CT suggested T 3 stage bladder cancer in left bladder wall, and causing left hydronephrosis. Under general anesthesia, robot-assisted laparoscopic radical cystectomy and complete intraperitoneal orthotopic ileal neobladder reconstruction were performed. The operation was successful, the postoperative recovery was good, and the patient was discharged 7 days after surgery. Postoperative pathological diagnosis was T 2b, high-grade urothelial carcinoma with left pelvic lymph node metastasis. Three months after operation, the patient had no recurrence, the new bladder function was good, the urine could be completely controlled during the day, and the intestinal and renal functions recovered well. At present, we carried out adjuvant chemotherapy (Gemcitabine+ Cisplatin)to this patient. The technical of radical cystectomy and orthotopic ileal neobladder with a history of surgery and radiotherapy is high, expensive experience in laparoscopic surgery and elaborate actions of robotic surgery are important prerequisites for completing such surgery.

The safety and efficacy of trimodality treatment for invasive bladder cancer / 中华泌尿外科杂志

Objective:To evaluate the safety and efficacy of trimodality treatment (TMT) which is complete transurethral resection of bladder tumor with concurrent radiotherapy and chemotherapy for invasive bladder cancer.Methods:From Mar. 2016 to Oct.2021, patients who were indicated of radical cystectomy (RC) but refused were enrolled to TMT treatment prospectively. Inclusive criteria were: ① the patients refused radical surgery; ② male or female, no older than 80 years; ③ no matter the tumor size, the bladder tumor be completely resected by transurethral surgery, and the hydronephrosis be improved after resecting the tumor; ④ the postoperative pathology of urothelial carcinoma; ⑤ recurrent T 1 and high-grade non-muscle invasive bladder cancer (NMIBC) or T 2-4a muscle invasive bladder cancer (MIBC); ⑥ no definitive metastasis in preoperative chest, abdominal CT or MRI; ⑦ hemoglobin ≥100 g/L, white blood cell count ≥4×10 9/L, platelet count ≥100×10 9/L, and normal liver and renal function. The exclusion criteria were: ① tumor invading bladder neck or anterior or posterior urethra; ② bladder contracture or severe urethral stricture; ③ regional lymph node metastasis or distant metastasis by imaging examination; ④ no improvement of hydronephrosis after resection; ⑤ definitive contraindications of radiotherapy or chemotherapy; ⑥ uncontrolled hypertension, diabetes, coronary heart disease or other severe diseases. After cTURBT, paclitaxel (50 mg/m 2 on Day 1 of each week) combined with cisplatin(20 mg/m 2 on day 1-2 of each week)was administered with concurrent radiotherapy (2 Gy/fraction/day) for 4 weeks. If cystoscopy and/or radiographic detected no recurrence or metastasis, the patients were treated with concurrent chemoradiotherapy for 2 and a half weeks (total dose of 64 Gy). The side effects of radiotherapy and chemotherapy during TMT were observed, the quality of life(QOL)was evaluated by FACT-P scale, and the bladder recurrence, distant metastasis and survival were assessed with imaging and cystoscopy. From March 2016 to October 2021, 79 patients with RC were enrolled, including 67 males and 12 females, aged 44-86 years. The pathology of RC was urothelial carcinoma of the bladder. There was no definitive lymph node or distant metastasis in preoperative imaging. The progress and survival after TMT and RC treatment were followed up and the survival rates were calculated by Kaplan-Meier method. Results:Of the 30 patients who underwent TMT, including 25 males and 5 females, aged 32-76 years, there were 7 cases of cT 1 (23.3%), 19 cases (63.3%) of cT 2, 2 cases of cT 3 (6.7%)and 2 cases of cT 4(6.7%), respectively. A total of 132 adverse events of all grades of chemoradiotherapy occurred, of which only 4 were grade Ⅳ, with no bowel leakage or death due to complications. The mean scores of negative questions in FACT-P were 3.22±0.67, 1.30±0.63 and 0.87±0.69 before TMT treatment, 6 and 12 months after TMT treatment, respectively. The quality of life was significantly improved( F=129.081, P<0.001), and the rate of bladder preservation was 86.7%(26/30). Two cases underwent salvage RC(6.7%)and 2 cases died of bladder recurrence(6.7%). There were 8, 4 and 2 patients survived 4, 5 and 6 years, respectively. Seven cases (23.3%) had bladder recurrence, 3 cases (10.0%) underwent distant metastasis and 6 patients (20.0%)died after TMT because of the progression. The 1, 2 and 5 year overall survival rates by TMT treatment were 88.89%, 82.96% and 62.77%, respectively. Median follow-up was 19.5(6.8-44.5) months in the TMT group and 35.5(18.8-53.3) months in the RC group ( z=-1.998, P=0.046). Progression-free survival in the TMT and RC group were 66.7% and 80.0%( χ2=1.047, P=0.306), and the overall survival rates were 80.0% and 80.0% ( χ2=0.482, P=0.488) respectively. The difference was not statistically significant. Conclusions:The TMT is a safe and effective alternative for RC, which can improve the quality of life and control the tumor sufficiently.

Multimodality bladder-sparing treatment options for muscle-invasive bladder cancer / 中华泌尿外科杂志

With the development of new drugs, advances in medical technology and progressions in tumor molecular biology, organ preservation surgery has become the new trend for tumor treatment. Here, we discussed how to select right muscle-invasive bladder cancer patient with strict criteria for multimodality bladder-sparing treatment, and we reviewed the new treatment options, outcomes and trend of development for bladder-sparing treatments.

Expert consensus of multi-disciplinary collaboration on bladder-preserving treatment for bladder cancer in China / 中华肿瘤杂志

Objective: Bladder cancer is one of the most common malignant tumors in urology. Urothelial carcinoma accounts for about 90% of all bladder malignancies. According to whether the tumor invades the bladder muscle, it can be divided into non-muscle invasive bladder cancer and muscle invasive bladder cancer. Radical cystectomy is the standard treatment for muscle invasive bladder cancer patients and high-risk non-muscle invasive bladder cancer patients who have failed Bacillus Calmette-Guerin treatment. Due to the comorbidity of bladder cancer and the potential deterioration of the quality of life after surgery, many patients were not suitable or refused for radical cystectomy. Therefore, it is vital to find a bladder-preserving treatment that can achieve cure other than radical cystectomy. Bladder-preserving therapy that balances tumor control and quality of life serves as an alternative and supplement to radical cystectomy. This consensus is based on contemporary evidence-based medicine, combined with the native clinical practice of bladder preservation in a multidisciplinary treatment manner. To some extent, this consensus serves as a guidance for bladder-preservation therapy of bladder cancer in China. Several issues are extensively discussed here, including organizational structure and workflow of multidisciplinary treatment, the selection of patients for bladder-preserving therapy, treatment options and regimens, follow-up, as well as regimen choices of recurrence after bladder-preserving therapy.

Status and progress of partial cystectomy in the treatment of myometric invasive bladder cancer / 中国综合临床

Bladder cancer is one of the most common malignant tumors in the urinary system, and the current standard treatment for muscle-invasive bladder cancer(MIBC) is radical cystectomy combined with pelvic lymphadenectomy.However, radical cystectomy is a surgical method with serious damege and high incidence of perioperative complications, leading to a low postoperative quality of life for patients.In recent years, with the improvement of chemotherapy regimens and the development of radiotherapy techniques, bladder preservation comprehensive therapy based on partial cystectomy(PC) has attracted the attention of domestic and foreign scholars again.This article reviews the current application and treatment progress of PC.

Comprehensive therapy of bladder preservation for muscle invasive bladder cancer / 中南大学学报(医学版)

The bladder cancer is a common malignant tumor in urinary system.The standard treatment for muscle invasive bladder cancer is radical cystectomy.Considering the damage to patients and the drastic effect on their life caused by the radical cystectomy,many domestic and overseas scholars suggest a comprehensive treatment based on a bladder-keeping surgery with adjuvant therapy including radiotherapy,chemotherapy and frequent follow-up,which showslow operation-related risk and complication rate compared with the radical cystectomy.As a result,patients are able to preserve the function of bladder.

Long-term outcomes of combined treatment of bladder-preserving surgery and adjuvant intraarterial chemotherapy for patients with stage T2 bladder cancer / 中华泌尿外科杂志

Objective To evaluate the efficacy of patients with stage T2 bladder cancer who underwent combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy.Methods The survival data of bladder cancer paients from January 2000 to December 2014 with stage T2N0M0 were retrospectively analyzed.Thirty-five patients of cT2N0M0 receive combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy(group A),and 80 patients of pT2N0M0 underwent radical cystectomy (RC) (group B).The pathological diagnosis of all patients was urothelial carcinoma.In group A,there were 33(94.2％) males and 2 (5.8％) females;20 (57.1％) tumor size less than 3 cm and 15 (42.9％) larger than 3 cm;24 (68.6％) with single tumor and 11 (31.4％) with multiple tumors;11 (31.4％) patients with primary tumors and 24 (68.6％) recurrent tumors.In group B,there were 71 (88.7％) males and 9 (11.3％) females;35 (43.8％) tumor size less than 3 cm and 45(56.2％) larger than 3 cm;44 (55.0％) with single tumors and 36 (45.0％) with multiple tumors;22(27.5％) patients with primary tumors and 58 (72.5％) recurrent tumors.Results Groups A and B consisted of 35 and 80 patients and median follow-up time was 68 (13-157)and 67 (4-198)months,respectively.There was no significantly statistical difference in disease-specific survival (DSS) between the two groups(P =0.888),76.5％ for group A and 60.6％ for group B respectively.In group A,26 (74.3％) patients achieved complete response (CR) to intra-arterial chemotherapy.Additionally,amounts of 21 (60.0％) patients preserve their functional bladder successfully and their median follow-up time was 69 (13-134)months.8 patients receive delayed radical cystectomy when suffered tumor recurrence and none of them had lymph node metastases.Of those pathological stage was presented as stage T2 5 cases,T3 2 cases and T4 1 case.Importantly,the 8 patients who receive delayed RC did not confer worse DSS when compared with those underwent immediate RC in group B (P =0.809).Cox proportional hazards model showed that tumor number and CR to intra-arterial chemotherapy was independent prognostic factor for disease-free survival (HR =0.238,P =0.007) and DSS(HR =0.085,P =0.004) respectively.During the period of intra-arterial chemotherapy,we did not observe hematological toxicity of grade Ⅳ and the hematological toxicity of grade Ⅰ-Ⅲ was 9 (25.7％),6 (17.1％) and 4 (11.4％).Conclusions For patients with T2N0M0,combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy could be a therapy with long-term survival outcome and safety.The therapy could be offered as alternative treatment option for patients who were unsuitable for receiving RC.

Concurrent chemoradiotherapy improves survival outcome in muscle-invasive bladder cancer

PURPOSE: To evaluate survival rates and prognostic factors related to treatment outcomes after bladder preserving therapy including transurethral resection of bladder tumor, radiotherapy (RT) with or without concurrent chemotherapy in bladder cancer with a curative intent. MATERIALS AND METHODS: We retrospectively studied 50 bladder cancer patients treated with bladder-preserving therapy at Keimyung University Dongsan Medical Center from January 1999 to December 2010. Age ranged from 46 to 89 years (median, 71.5 years). Bladder cancer was the American Joint Committee on Cancer (AJCC) stage II, III, and IV in 9, 27, and 14 patients, respectively. Thirty patients were treated with concurrent chemoradiotherapy (CCRT) and 20 patients with RT alone. Nine patients received chemotherapy prior to CCRT or RT alone. Radiation was delivered with a four-field box technique (median, 63 Gy; range, 48.6 to 70.2 Gy). The follow-up periods ranged from 2 to 169 months (median, 34 months). RESULTS: Thirty patients (60%) showed complete response and 13 (26%) a partial response. All patients could have their own bladder preserved. Five-year overall survival (OS) rate was 37.2%, and the 5-year disease-free survival (DFS) rate was 30.2%. In multivariate analysis, tumor grade and CCRT were statistically significant in OS. CONCLUSION: Tumor grade was a significant prognostic factor related to OS. CCRT is also considered to improve survival outcomes. Further multi-institutional studies are needed to elucidate the impact of RT in bladder cancer.

Bladder Preservation Strategies for Treatment of Muscle-Invasive Bladder Cancer: Experience of 7-Year Follow up / 대한비뇨기과학회지

PURPOSE: Currently, the initial treatments of muscle-invasive bladder cancer can be divided into bladder preservation strategies and radical cystectomy. We report our long-term clinical experience of multimodality therapy, using bladder preservation strategies, in patients with muscle-invasive bladder cancer. MATERIALS AND METHODS: Between 1991 and 1994, 23 patients, with a muscle-invasive transitional cell carcinoma of the bladder, underwent a rigorous transurethral resection of the bladder tumor, followed by concurrent cisplatin containing chemotherapy and radiotherapy. The patients' response to the treatment was evaluated with cystoscopy, urine cytology, chest radiography, abdominal-pelvic CT and whole body bone scans following completion of the treatment. Prognostic factors, such as T stage, tumor shape, tumor grade, and initial tumor resection status, were analyzed and the overall 5-year survival rate and disease-specific 5-year survival rate estimated. RESULTS: Of the 23 patients, 3 required a radical cystectomy due to a tumor recurrence. The T stage and initial tumor resection status seemed to be the most significant prognostic factors. The overall 5-year survival rate and disease-specific 5-year survival rate were 64 and 71% (stage T2, 62% and 83%; stage T3, 64% and 63%; stage T4: 0%), respectively, and the rate for retaining a functional bladder was 50%. CONCLUSIONS: Our actuarial 5-year overall and disease-specific survival rates were comparable with those reported for a contemporary radical cystectomy, and with other studies on multimodality bladder sparing treatments for patients at similar clinical and pathological stages. Multimodality treatment, with bladder preservation, can be regarded as an efficacious treatment, with most long-term survivors retaining functional bladders.

Advances in combined therapy with bladder preservation for invasive bladder cancer / 中国癌症杂志

The golden standard for the treatment of invasive bladder cancer is radical cystectomy. However its application is limited in certain circumstances because of surgical trauma,complications,and impacts on quality of life. As organ preservation protocols have become the standard in the treatment of some malignancies such as breast cancer、anal cancer、esophageal cancer,the multimodality treatment with bladder preservation was introduced to cure invasive bladder cancer, which can retain normal bladder function without a marked compromise of overall survival and is a viable, reasonable alternative for the treatment of invasive bladder cancer. This review highlights the advances in multimodality treatment with bladder preservation for invasive bladder cancer.

Combined Modality Therapy with Selective Bladder Preservation for Muscle Invading Bladder Cancer / 대한방사선종양학회지

PURPOSE: To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. METHOD AND MATERIALS: From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by 39.6~45 Gy pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. RESULT: The patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients (81%) successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients (58%) were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were 80% and 14%, respectively (p=0.001). CONCLUSION: In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

Combinations of neoadjuvant chemoradiotherapy and transurethral resection for bladder cancer with muscle invasion / 中国癌症杂志

Purpose:To evaluate the efficacy of bladder p re servation treatment by concurrent neoadjuvant intra-arterial chemotherapy, radi otherapy and transurethral resection for patients with bladder cancer with muscl e invasion. Methods:Thirteen patients who were unfit for or unwilling to re ceive radical cystectomy were enrolled in this study. All patients had muscle in vasive transitional cell carcinoma of bladder(T 2-T 3). Patients were treated with neoadjuvant intra-arterial chemotherapy, radiotherapy and transurethral r esection. The chemotherapy regimen consisted of cisplatin 80 mg, epirubicin 50 m g and fluorouracil 1 g/camptothecin 30 mg. The average dose of radiotherapy was 30-50 Gy. Results:At the end of neoadjuvant therapy, 1 patient (7.69%) sh owed a complete response and 12 patients (92.31%) showed partial response; tran surethral resection was performed for residual tumors. All patients completed th e treatment and showed good tolerance. With a median follow-up of 26.46 months, local recurrence or distant metastasis occurred in 5 patients (38.46%). Recurre nt tumors were treated with transurethral resection or systematic chemotherapy a nd radiotherapy. Conclusions:concurrent neoadjuvant intra-arterial chemotherapy , radiotherapy and transurethral resection is a feasible and promising treatment for patients with bladder cancer with muscle invasion.

Effectiveness of Bladder Preservation Treatment For Patients with Superfcially Invasive Bladder Tumor(T2/T3a) / 대한비뇨기과학회지

Radical cystectomy and/or radiotherapy represent the standard treatment for invasive bladder carcinoma. However these approaches are less than ideal since a substantial number of patients have progressive disease and die of metastatic cancer. Then recent treatment modality is trending toward chemotherapy. Therefore, we performed the aggressive transurethral resection of the bladder tumor (TURBt) followed by the combined chemotherapy of methotrexate, vinblastine, doxorubicin and cisplatin(RI-VAC) for conservative treatment of muscle invasive transitional cell carcinoma of the bladder. From July 1990 to March 1995, 41 patients with stage T2 to T4 were entered into the study. Of that patients, 26 completed 4 to 8 cycles of M-VAC and were followed, while 15 were excluded from the study because of incomplete chemotherapy or inadequate follow-up. Median follow-up was 30 months(4-56 months). Median age of the patients was 66 years(range 48 to 85 years). All patients had Karnofsky performance status(KPS) score between 70 and l00. There were 3 patients with clinical stage T2, 8 with T3a, 7 with T3b, 8 with T4. G-CSF(Granulocyte-Colony Stimulating Factor) was used for 19 patients with M-VAC induced leukopenia, thereby allowing the chemotherapy to be complete on schedule. Responses to therapy were evaluated according to standard accepted phase II response criteria. Overall clinical response (complete and partia1) was noted in 15 patients(58%), and no response in 11(42%). Of the patients with T2 and T3a, 9(82%) showed complete and partial response, and of them with T3b and T4, 6(40%) showed complete and partial response. Of 26 patients 21(81%) are alive now. These data suggest that survival was no better than expected following radical cystectomy or radiotherapy in short term follow-up, so far, however systemic M-VAC chemotherapy in combination with radical TURBt is probably expected to provide a high response rate and a better survival with the particular advantage of preserving normal bladder function in patients with superficially invasive bladder tumor(T2/T3a).

A Histopathologic and Morphologic Study for Bladder Preservation in the Management of Invasive Bladder Tumors / 대한비뇨기과학회지

This study was designed to define the subgroup of patients with invasive bladder tumor who could be candidates for bladder preservation. Medical records of 50 patients with muscle invasive transitional cell carcinoma of bladder who underwent radical cystectomy in our hospital from March l983 to December l992 were reviewed. Tumor size, number, configuration, number of recurrence and grade at the time of TUR-B were compared to pathologic stage and lymph node status from radical cystectomy specimens. Pathologic stage such as P0, Pis, Pa, P1, P2 ( Group I) were defined to be superficially invasive tumor group in which bladder could possibly be preserved with TUR-B and P3a,P3b, P4(Group II) were defined to be deeply invasive tumor group in which bladder could not be preserved with TUR-B. The frequency of P0 and Group I of 50 cystectomy specimens were 8% and 46%. Among various factors evaluated, tumor configuration and size (less than 4cm) were the most significant ones discriminating superficially invasive from deeply invasive group(p<0.05). If bladder preservation modality using TUR-B is applied with this criteria, sensitivity, specificity. positive and negative predictive value were 57%, 74%, 65% and 67% respectively. In conclusion, papillary, small-sized tumors (less than 4cm) are likely to be superficially invasive and thus bladder preserving modality could be applied in this subgroup.

Bladder Preservation Trial in Locally Advanced Bladder Cancer / 대한비뇨기과학회지

Twenty three patients with locally invasive transitional cell carcinoma of the bladder(stage T2-T4N0M0) who refused to undergo radical cystectomy or were poor surgical candidates were included in this study. All patients received transurethral resection(TUR) of the tumor initially for the pathologic staging and debulking of tumor mass. Then, patients were treated with either one of the following two bladder preservation protocols. First trials consisted of initial 2 courses of MVAC(methotrexate, vinblastin, adriamycin and cisplatin) chemotherapy and followed by radiotherapy( 6480cGy) plus 2 courses of cisplatin. The other protocol was initial radiotherapy ( 6480cGy) with 2 courses of cisplatin and additional 2 courses of MCV(methotrexate, cisplatin and vinblastin) chemotherapy. There were 8 patients in T2, 13 in T3 and 2 in T4. Repeat biopsies were conducted 1 to 6 months after initiation of therapy. With a mean follow up of 17.1 months, other than two patients who underwent cystectomies, the survival rate without local recurrence or distant metastasis was 66.6% (14/21)-87.5 % ( 7/8) in T2. 63.6 % ( 7/11) in T3 and 0%(0/2) in T4. Bladder tumor recurrence and metastasis was observed in 3 patients respectively. One patient in stage T4 died at 20 months with multiple metastasis. The survival rate is closely correlated to initial stage. Patients with no residual mass after TUR seemed to be better in response than patients with residual mass. Side reactions such as neutropenia ( <2000/ mm3) were observed in 6(26.2% ) patients, radiation cystitis in 2(8.7% ) and radiation proctitis in 1(4.3%) The bladder preservation protocol in locally invasive bladder tumor has relatively satisfactory results but longer follow-up is necessary to determine the efficacy of current protocol in long term survival.