Complex organ-sparing treatment for muscle-invasive bladder cancer

Abstract

Background. Bladder cancer ranks 9th in prevalence among malignancies and 2nd among malignant tumors of the human urogenital system. Cysttetomy significantly reduces the quality of life and contributes to the emergence of postoperative complications that can lead to the patient’s death during the first year after the surgery. Along with organ removal in the cases of muscle-invasive bladder cancer (MIBC), organ-sparing operations can be performed on the bladder, which can be an effective alternative to radical cystectomy. Purpose – of the study was to conduct the analysis of the benefits and the oncological results of MIBC treatment using multimodal organ-sparing therapy in comparison with radical cystectomy with ileocystoneoplasty. Materials and Methods. Depending on the treatment method, the patients were divided into 3 groups. The first group included 36 (48,6%) patients who underwent radical cystectomy with ileocystoneoplasty; in the 2nd group there were 22 (29,7%) patients after TUR of bladder tumor with adjuvant chemotherapy; in the 3rd group – 16 (21,6%) patients after TUR of bladder tumor with adjuvant chemoradiation therapy. The patients were selected according to generally recommended criteria for bladder preservation. Overall survival rate, as well as cancer-specific and recurrence-free survival rate was assessed by the Kaplan–Meier method. The median age of the patients in the 1st group was 67 years (in the range from 51 to 76 years old), in the 2nd group – 72 (in the range from 53 to 78 years old), in the 3rd group – 74 (in the range from 62 to 81 years old). Results. The findings show that cancer outcomes are unlikely to differ between the three groups over a five-year follow-up period, but given the significantly better quality of life in MIBC organ-sparing treatment groups, the usage of trimodality therapy for MIBC in selected patients is justified. Up to 19% of patients with MIBC may become potential candidates for organ-sparing treatment (TURB). Adequate local control of the tumor can not be achieved with monotherapy alone (TUR, chemo and/or radiation therapy), but the combination of these methods provides adequate local cancer control. The patients who received complex therapy in presented studies showed fair cancerspecific and overall survival rate. Conclusions. The study proved that bi- and trimodality organ-sparing treatment allows commensurable values of overall, cancer-specific and recurrence-free survival rate to be achieved in comparison with radical cystectomy for selected patients with non-metastatic MIBC. Taking into account the better quality of life, complex organ-sparing therapy – TURD with chemo- and/or radiation therapy, can be considered as an alternative to radical cystectomy in the cases of MIBC.