The Value Of Bladder Surgery Combined With Radiotherapy And Chemotherapy In Myometrial Invasive Bladder Cancer (MIBC)

Objective To evaluate the therapeutic effect of bladder-sparing therapy combined with chemotherapy and radiotherapy for muscle invasive bladder cancer(MIBC).Methods Data of 72 patients with MIBC from January 2003 to August 2010, including 42 cases of MIBC underwent bladder-sparing treatment, and 30 cases underwent radical cystectomy were analyzed retrospectively. Of the 42 patients,28 underwent partial cystectomy;14 underwent TURBT;5 underwent radiotherapy because of incomplete resection or positive resection margines.All these 42 patients maintained chemotherapy..Kaplan-meier method and Log-rank test were used to analyze overall survival.Results A total of 72 patients with MIBC were followed up for 12 to 92 months(mean 43.1 months,median 50 months),including 54 males and 18 females,with a median age of 67.3(range 40 to 85).In bladder-sparing group,localised relapse occured in 24 patients(16 non-muscle invasive relapse,8 muscle-invasive relapse).6 muscle-invasive relapse were treated with TUBBT or PC,combined with chemotherapy or radiotherapy.1 patient was treated with salvage RC.1 patient was treated with palliative TURBT.In the bladder-sparing treatment group,the mean survival time was 50.721 months,the median was 47 months.In the RC group the mean survival time was 57.540 months,the median was 52 months. During the follow-up of 12-92 months,34 patients died,including 21 cases(50%) underwent bladder-preserving treatment and 13 cases(43%) underwent radical resection.The survival rate of bladder-preserving treatment group after 1, 2, 3, 4, 5 year were 88.1%、83.3%、61.9%、57.1%、47.6%, respectively, and the radical resection group were 86.7%、80.0%、66.7%、63.6%、53.3%. There was no significant diferrence between the two groups(P>0.05).Conclusions 1、PC or TURBT combined with chemotherapy or radiotherapy for the treatment of MIBC can reach a similar survial rate with that of radical cystectomy. 2、Multimodality bladder-preserving treatment is a reasonable choice for the patients who refuse RC or can not tolerate RC because of bad physical condition.