Introduction: The standard treatment of muscle infiltrative bladder cancer is radical cystectomy with neoadjuvant cisplatin based chemotherapy. Trimodally treatment with maximal TUR followed by concurrent radio-chemotherapy is an alternative in adequate selected patients with localized disease or those that are not candidates for surgery or refused it. There are not randomized trial comparing both modalities , so data comes from different experiences around the globe.
Objective: We describe our experience , one of the biggest one in Latin America , considering patients characteristics , treatment modalities and follow up with toxicities and DFS and OS .
Materials and methods: Retrospective analysis of patients treated between January 1995 to July 2017 in ISTITUTO ALEXANDER FLEMING, Buenos Aires , Argentina. Patients had muscle invasive localized or locally-advanced transitional cell carcinoma.
We treated 79pts;median age 65 yo (40-89); male 81% (64p)/female 19% (15p); smoking history :59% (47p); Stage : II: 82%(65p), III 11%(9p), IV 6%(5p); Histological type : pure transitional 91% (72p), with adenocarcinoma differentiation 4%(3p), squamous diff 5%(4p), other 4%(3p).
Initial maximal TUR was performed in all patients with 21%(17p) having macroscopic residual disease after 1 or 2 procedures; 49%(39p) received induction chemo: CBDCA+gemcitabine 26%(10p), CMV or GC 28%(11p) y MVAC 10%(4p); sequential chemotherapy 2%(2p), all others concurrent with : CDDP 73%, CBDCA 20%, other 7%.
Radiation dose ; 60Gy 90%(71p), 50Gy 2%(2p), 46Gy 4%(3p); RT including lymph nodes areas 6%(5p); Toxicity: Acute 50%(40p): cystitis 85%(34p), enteritis 17%(7p), Chronic 9%(7p): cistitis 70%(5p), G III-IV 5%(4p); Split of RT 5%(4p).
Median follow up 60 months (r3-252); Recurrence 30%(24p): local 67%(16p), distant 42%(10p).
Conclusion: In correctly selected patients and some that there are not candidates to surgery well performed trimodally treatment offers an alternate with excellent results after prolonged follow up . The most appropriate treatment is not fully defined thats why there is some heterogeneity in the schema. Toxicity is manageable . This type of retrospective data adds to other series with similar results in other continents.
