Detalle Publicación


Response and progression- free survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation.

Autores: Rincón Mayans, Aníbal Pablo; Rosell Costa, David; Zudaire Bergera, Juan Javier; Rioja Zuazu, J; Barba Abad, Javier Fermín; Tolosa Eizaguirre, Egoitz; Romero Vargas, Luis Miguel; Pascual Piedrola, Juan Ignacio
ISSN: 0210-4806
Volumen: 34
Número: 9
Páginas: 775 - 780
Fecha de publicación: 2010
Objective: To evaluate the response and the free-survival progression in pacients diagnosed of invasive bladder cancer who have been treated with transurethral resection, chemotherapy and radiotherapy. This multimodal treatment is compared with a not random serie of patients treated by radical cistectomy. Material and methods: Retrospective analysis of 43 cases of invasive bladder cancer treated with two schemes of bladder preservation between 1994-2007. They are compared with 145 cases treated with radical cistectomy in the same period of time. Pronostic variables included in the study are clinical stage, grade of differentiation, presence of ureteral obstruction, chemotherapy modality, radiotherapy doses and p53 and ki-67 expression. Results: Mean and median time are 51 and 39 months in patients with multimodal treatment. Complete response is achieved in 72% of cases treated with bladder preservation. Ureteral obstruction is a prognostic factor (OR: 7,3;p:0,02). 72% patients with complete response mantain it at the end of the study. None of analyzed variables are predictors of maintenance of the response. Survival rates with a intact bladder were 69 +/- 7% and 61 +/- 7% at three and five years. Radiotherapy doses greater than 60 Gy (OR: 6,1; p < 0,001) and the absence of ureteral obstruction (OR: 7,5; p < 0,002) were pronostic variables. Free-survival in patients with complete response was 80 7% and 58 +/- 10% at three and five years. At the end of the study, 53,5% of patients had a intact bladder and free-disease. In the same period of time, 145 radical cistectomies were performed due to muscle invasive bladder cancer. Mean and median time in this group were 29 and 18 months respectively. Stadistical analysis reveals a worse clinical stage in the group of patients treated with multimodal treatment (p:0.01). Free-survival was 72 +/- 5% and 63 +/- 7% at 3 and 5 years in the group of radical cistectomies. There was not stadistical significant differences between cistectomies and bladder preservation. Conclusions: Patients treated with bladder preservation have a free-survival similar to those treted with radical cistectomy. Radiotherapy doses greater than 60 Gy and absence of ureteral obstruction were free-survival prognostic variables. (C) 2010 AEU. Published by Elsevier Espana, S.L. All rights reserved.