Bladder preservation by neoadjuvant chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer: Experience at Sindh Institute of Urology & Transplantation (SIUT)

Objective: to identify any additional benefit and note the safety profile of neoadjuvant chemotherapy prior to concurrent chemoradiation in muscle-invasive bladder cancer.methods: forty three patients with t2b-t4n0m0 bladder cancer underwent maximal turbt followed by neoadjuvant chemotherapy cisplatinum 75mg/m[2] d1+ gemcitabine 1000mg/m[2] d1, d8 & d15 repeated every 28 days for three cycles followed by concurrent radiation 65gy and weekly cisplatinum 30mg/m[2] or gemcitabine 100mg/m[2]. complete response (cr) was defined as no tumour seen on cystoscopy and biopsy.the disease control and overall survival were determined by kaplan and meier method and statistical inferences with the log-rank test. cox regression analysis was used to find different prognostic factors.results: out of 43, thirty two patients (78.04%) achieved cr at time of cystoscopic evaluation. six patients who did not achieve cr (14.63%) underwent salvage cystectomies, remaining were not operable. at the median follow up of 36 months, overall survival was 61%. local recurrences were seen in 3 patients (10%) (2 pt1, 1pt2), distant metastases were seen in 2 patients (6.6%); 27/41 were alive, of whom 23 (56.1%) were retaining intact disease free bladders. the tumour stage, incomplete turbt and presence of hydronephrosis were important prognostic factors (log-rank p values 0.0001, 0.0001 and 0.001 respectively).conclusion: neoadjuvant chemotherapy followed by concurrent chemoradiation was tolerable with better bladder preservation and overall survival.