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Concurrent chemoradiotherapy for muscle-invasive bladder carcinoma for organ preservation: A feasibility study from tertiary care center

Anjan Bera, Shatarupa Dutta.


Abstract

Background: The primary goal of treatment in oncology is cure but efforts should be made to preserve quality of life. The gold standard for treatment of muscle-invasive bladder cancer is radical cystectomy. However, radical cystectomy cannot be performed without risk of complications and often the outcome for the patient is a mediocre quality of life as the patient has to live with an artificial bladder or ileal conduit. Even after radical cystectomy, 40–50% of patients will succumb to distant metastases within 5 years. As in the case of several other malignancies, increasing efforts have been made over the last few decades to adopt organ sparing treatment. Bladder-sparing monotherapies lead to disappointing results, local disease control may be maximized using a trimodal approach based on complete transurethral tumor resection of bladder (TURB), followed by concurrent chemoradiotherapy and cisplatin-based systemic chemotherapy.

Objectives: The aim of our study is feasibility of concurrent cisplatin with radiation in bladder preservation in our hospital.

Materials and Methods: Thirty-two previously untreated patients of histologically proven transitional cell carcinoma of urinary bladder received concurrent chemoradiation (60 Gy) with cisplatin. All patients received concurrent chemotherapy with cisplatin infusion in a dose of 20 mg/m2/day on consecutive 5 days from Day 1 to Day 5 in 1st and 5th week of radiotherapy. Detailed clinical examination along with cystoscopy, TURB along with biopsy, and computed tomography scan of abdomen pelvis were done before treatment and to assess response toxicity, and disease-free survival (DFS) during follow-up period.

Results: Median follows up period was 36 months. Local disease control was seen in 71% patients. Five years DFS is 58%. Five years overall survival is 64%.

Conclusions: Concurrent chemoradiation in carcinoma of urinary bladder is feasible in our hospital and results in good local control, survival with acceptable toxicity.

Key words: Bladder Cancer; Chemoradiotherapy; Cispaltin






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