The Efficacy of Bimodality Therapy for Organ Preservation in Locally Advanced Bladder Tumor

Yoon, Dong Jin; Kim, Young Joo; Chang, Sung Goo

Abstract

PURPOSE: We evaluate the efficacy of bimodality therapy for organ preservation in locally advanced bladder tumors.
MATERIALS AND METHODS
A total of 23 patients with a clinical stage T2- T4aN0M0 bladder tumor were included in our study and treated with transurethral resection or partial cystectomy by chemotherapy. They are composed of T2: 6, T3: 11, T4a: 6 cases in stage, W.H.O. LMP (low malignant potencial): 1, low grade: 9, high grade: 13 cases in pathologic grade. The followed chemotherapy regimens were composed of M-VAC (methotrexate 30mg/m2, vinblastine 3mg/m2, adriamycin 30mg/m2, cisplatin 70mg/m2), S-MEC (methotrexate 30mg/m2, epirubicin 50mg/m2, cisplatin 100mg/ m2), and gemcitabine (100mg/m2)-cisplatin (70mg/m2) in 10, 8, and 5 cases, respectively. The evaluation of response was performed by transurethral biopsy, urine cytology, CT, and MRI after more than 4 cycles of postoperative chemotherapy.
RESULTS
A complete response was achieved in 10 patients (43.5%), and a partial response occurred in 3 patients (13.0%) to give an overall response rate of 56.5%. The mean duration of complete responses was 35.5 months. Eight of 23 patients are still alive. The mean duration of the follow-up was 41.6 months, and their 5-year survival rate was 33.3%. Low stage, initial response to therapy, and no evidence of hydronephrosis were all significant predictors for an increased probability of organ preservation.
CONCLUSIONS
Transurethral resection or partial cystectomy followed by chemotherapy result in long-term bladder preservation in a significant proportion of responding patients, and may be a comparable therapy to trimodality therapy in select patients in locally advanced bladder tumors.