A feasibility study of transurethral resection followed by radiotherapy combined with concurrent twice-weekly gemcitabine in the treatment of invasive bladder carcinoma

Dalia Osama, Mohamed Shalaby, Mohamed Abdelhamed Aboziada


Introduction and Aim: Radical cystectomy is the traditional treatment of cancer bladder; however, bladder preservation in selective patients is beneficial. To evaluate the efficacy of transurethral resection plus chemo-radiation in achieving bladder preservation, using conformal radiotherapy and twice weekly Gemcitabine.

Patients and Methods: Thirty seven patients with good performance status, and maximum trans-urethral resection received 46GY /23 fractions with twice weekly Gemcitabine 30mg/m2. Evaluation was done after 2 weeks by cystoscopy and biopsy from the tumor bed. Patients who had complete response (CR) subjected for phase II 20 GY/10 fractions /2 weeks with twice weekly Gemcitabine 30 mg/m2. However, patients who had incomplete response subjected for radical cystectomy.

Results: Thirty two (86.4%) patients had CR. The treatment schedule was tolerable and was associated with moderate toxicity that was easily treated. Six patients developed G3 toxicity that required treatment interruption until improvement. After 2 years of follow up, 29 patients achieved good local control with 2 years local recurrence free survival was 79%. The 2 years overall survival and bladder intact survival was 70% and 69% respectively.

Conclusions: Tri-modality bladder-sparing approach consists of transurethral resection, chemotherapy twice weekly Gemcitabine and radiotherapy is well tolerated, with high rate of bladder preservation. This approach may be considered as a reasonable alternative to cystectomy in the proper selected patients.

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DOI: https://doi.org/10.5430/jst.v3n3p1

Journal of Solid Tumors

ISSN 1925-4067(Print)   ISSN 1925-4075(Online)

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