Efficacy of Bladder Preservation Protocols in the Management of Muscle Invasive Bladder Cancer
Iraqi Postgraduate Medical Journal,
2018, Volume 17, Issue 1, Pages 29-35
As an alternative to the standard of care for muscle-invasive bladder cancer, certain bladder preservations protocols should be offered to patients with significant co morbidities or for those keening intact bladder and not so compliant with cystectomy approach provided that they included in strict criteria.
To review the efficacy of bladder preservation therapy for muscle-invasive bladder cancer (MIBC) for selected patients by non-randomized prospective study over two years follow up period.
A study started from a January -2014 until October -2016, twenty eight Patients were included in combined prospective and retrospective manner; they were included within those two years. Patients were confirmed having muscle invasive disease if initial TURBT or the 2nd look TURBT specimens were showed a muscle invasive bladder cancer. All candidates included in bladder preservation strategies shared common strict inclusions criteria. Cisplatin-based chemotherapy and split- course chemo radiation therapy then was offered for all patients after radical TURBT and re assessment carried out after the 3rd cycle of chemotherapy and or 40 GY radiotherapy 3 months later, patients with response after 2nd look TUR were offered other 20 GY radiotherapy.
Initial clinical response was assessed after 3 months from initial resection (after completion of 3 cycle chemotherapy). Those were subjected to preservation trial, 22(78.5 %) achieved complete response, 4(14.3%) achieved partial response, and 2(7.1%) had no response. Out of responsive group (22 patients), two patients developed recurrent pattern, one of them at first year and another one in the second year, so for over all response assessment obtained for two years there were 28 patients : Twenty patients (72%) were cancer clear, Eight patients (28%) had failed response. No mortality recorded at the study period. All recurrent cases were offered salvage radical cystectomy.
Bladder preservation protocols in selected patients with MIBC might be an effective alternative to standard radical cystectomy with pelvic lymph nodes dissection in controlling low volume favorable invasive and high grade multifocal bladder tumors in up to 70 % of patients.
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