Radical trimodality therapy for patients with locally advanced bladder cancer: The British Columbia Cancer Agency experience

Abstract

Purpose: To assess the outcomes of patients with locally advanced bladder cancer (clinically T3b-T4 or N+and M0) who were referred to the British Columbia Cancer Agency and treated with radical trimodality therapy (RTMT). RTMT consists of transurethral resection of the tumor, followed by both chemotherapy and radiation.

Methods: Between 1997 and 2007, 380 patients with cT3b-cT4 or N+ M0 bladder cancer were referred to the British Columbia Cancer Agency. Of these patients, 50 (13%) were treated using RTMT (all with platin-based chemotherapy and median radiation dose of 60Gy). Patient and disease characteristics as well as treatment data were retrospectively recorded through a chart review. Study end points included overall survival (OS), bladder cancer-specific survival (BCSS), and local relapse-free survival (LRFS).

Results: Median follow-up period for surviving patients was 8.53 years. At 5 and 10 years, OS was 30% and 17%, BCSS was 31% and 27%, and LRFS was 60% and 50%, respectively. Complete local response on first cystoscopy following treatment was the only significant predictor of OS, BCSS, and LRFS on univariate analysis, and it was also a significant predictor for LRFS on multivariable analysis.

Conclusions: RTMT is a reasonable alternative to radical cystectomy in patients with locally advanced disease who are either unfit for or unwilling to undergo cystectomy.

Keywords: Chemotherapy; Locally advanced bladder cancer; Radiation; Radical trimodality therapy; Urothelial carcinoma.