Outcome of Organ Sparing Trimodality Treatment of Muscle Invasive Bladder Cancer

Background: Radical cystectomy leftovers the fundamental healing approach for muscle-invasive bladder cancer. However, there has been notable success in preserving the bladder through trimodality treatment, utilizing a mixture of the most significant Trans urethral resection of bladder tumor (TURBT) and chemo-radiation therapy.[1] The contemporary landscape of oncologic interventions is progressively inclined towards preserving organ function, optimizing functional outcomes, and upholding treatment effectiveness and quality of life (QoL). This Trimodality Therapy (TMT) encompasses Maximal TURBT, Radiation therapy, and Chemotherapy. Aim of the study was to observe the tumor response to treatment by concomitant Chemo-Radiation (TMT).

Methods: A quasi-experimental study of 47 patients with muscle-invasive bladder cancer who were ineligible for radical cystectomy was conducted from January 2012 to January 2019. Patients received induction chemotherapy with gemcitabine and cisplatin and radiotherapy with volumetric or intensity-modulated arc therapy. The median follow-up was 40 months, and the 5-year and recurrence-free survival rates were 59% and 50%, respectively.

Results: Trimodality therapy, combining surgery, radiation, and chemotherapy, demonstrated promising outcomes for muscle-invasive bladder cancer (MIBC) treatment. The 5-year Overall Survival (OS) rate reached 59%, surpassing the typical <50% rate. Disease-free survival (DFS) at 5 years was 50%. Completion rates varied among studies (NCI CTAE 21.30%, Our Study 12.70%, RTOG 6%), attributed to study criteria and resources. Despite differences, all contribute valuable MIBC treatment data. These findings endorse trimodality therapy as a standard MIBC treatment, offering optimal survival prospects.

Conclusion: Trimodality bladder preservation treatment presents a viable substitute for radical cystectomy for individuals who seek to maintain their bladder.