Avtor/Urednik		Červek, Jožica; Čufer, Tanja; Zakotnik, Branko; Kragelj, Borut; Borštnar, Simona; Matos, Tadeja; Žumer-Pregelj, Mirjana
Naslov		Invasive bladder cancer: our experience with bladder sparing approach
Tip		članek
Vir		Int J Radiat Oncol Biol Phys
Vol. in št.		Letnik 41, št. 2
Leto izdaje		1998
Obseg		str. 273-8
Jezik		eng
Abstrakt		Purpose: Muscle-invasive bladder cancer (MIBC) is a disease associated with several unresolved therapeutic questions. Radical cystecomy still represent the most frequent treatment approach. The aim of our study to evaluate the effect and feasibility of bladder-sparing treatment by transurethal resection (TUR) and sequential chemoradiotherapy in patients with biopsy-proven invasive bladder cancer. Merthods and material: After maximal TUR, 105 patients were treated with two to four cycles of methotrexate, cisplatinum, and vinblastine polichemotherapy. In complete responders, the treatment was continued by radiotherapy, (50 Gy to the bladder and 40 Gy to the regional lymph nodes), whereas in nonrespoders, cystectomy was performed when feasible. Results: Complete response after TUR and chemotherapy was achived in 52% of patients. After a median follow-up 42 months, 52 patients of 75 patients (69%) selected for bladder presevation were without evidence of disease in the bladder. From local failure in complete responders to chemotherapy was 80% (95% confidence interval (CI), 69-91%) at 4 years. The actuarial survival of entire group was 58% (95% CI, 47-69%), whereas the survival rate with the bladder intact was 45% (95% CI, 34-56%) at 4 years. Survival was significantly better in patients who responded to chemothetapy (79%) then nonresponders (35%, p<0.0001). There was no significant difference in survival between nonresponders who underwent cystecomy and nonresponders who completed treatment with radiotherapy (approximately 30% at 3 years). Conclusion: the present study confirms that MIBC is a heterogenous disease, and that in more than half of patients who are affected, a bladder-sparing approach is safe. Our study has also demonstrated that in nonrespoders, radical cystectomy as the treatment of choise is questionable.
Deskriptorji		BLADDER NEOPLASMS COMBINED MODALITY THERAPY SURVIVAL ANALYSIS CYSTECTOMY CARCINOMA, TRANSITIONAL CELL