The standard care for muscle invasive bladder carcinoma (MIBC) in the United States for a long time was radical cystectomy where as in Europe, it is radical radiotherapy or multidrug regimen neoadjuvant chemotherapy followed by radiotherapy. In spite of the importance in terms of incidence, prognosis and cost, bladder cancer research remains significantly underfunded so the studies and data on organ preservation in MIBC in India are less explored.
We analyzed the data of 30 patients of MIBC from 2016-2018 who underwent primary transurethral resection of bladder tumour (TURBT) followed by IMRT with 64.8 Gy and weekly cisplatin at dose of 40 mg/ m2 with median follow up of 10 months. The role of various factors like tumour stage, histopathology, grade, complete TURBT, obstructive uropathy on locoregional response and disease free survival was evaluated. Local reactions evaluated using CTCAE criteria version 5.0. Statistical analysis was done using SPSS version 23.0.
Demographic and disease characteristics
Age Median – 68 Yrs Range – 52 - 80 Yrs Sex Male – 86.7% (n=26) Female – 13.3% (n=4) Turbt Complete – 33.3% (n=10) Incomplete – 66.7% (n=20) Histopathology Transitional – 86.6%(n=26) Squamous – 6.7% (n=2) Adeno CA – 6.7% (n=2) Grade Grade I – 6.7% (n=2) Grade II – 26.6% (n=8) Grade III - 66.7% (n=20) Tumour Stage T2 – 53.3 % (n=16) T3 – 33.3 % (n=10) T4 – 13.4 % (n=4) Obstructive Uropathy Present – 33.3 % (n=10) Absent – 66.7% (n=20) Locoregional Response Complete – 73.3% (n=22) Partial – 20% (n=6) Progression – 6.7% (n=2)
After the treatment, the complete locoregional response (LRR) was 73.3%. Early (T2 stage) tumours (p= 0.043) and patients without obstructive uropathy (p= 0.039) have shown significant LRR. Patients with complete TURBT, Low grade tumours shown increased response though statistically not significant. The overall disease free survival in this study for the preserved bladder patients is 53.3%. Patients without obstructive uropathy have shown significant DFS of 70% (p=0.026). Improved DFS of patients with T2 stage tumours (75%), complete TURBT (60%), low grade tumours was observed though statistically not significant. GU toxicities like dysuria, burning micturition in 40% of patients, increased frequency of micturition in 20% of patients, gastro intestinal toxicities like constipation (40%), pain abdomen (6.7%) were observed during followup and all these are grade I,II and managed well with supportive treatment.
Bladder preservation in more than 70% of patients in this study supports the general concept of organ sparing treatment in oncology. The high response rate and DFS were observed in south Indians with complete TURBT, early stage tumours, no obstructive uropathy and low grade tumours. The genito urinary & gastro intestinal toxicities are comparatively less, probably in view of using IMRT technique and single agent cisplatin.
Dr Himani Manchala.
Has not received any funding.
All authors have declared no conflicts of interest.