Background:
Radical cystectomy is reference management of muscle-invasive bladder cancer (MIBC), with a reduced quality of life after cystectomy.
Our study aimed to assess the efficacy of neoadjuvant chemotherapy (NAC) followed by concurrent chemoradiotherapy (CCRTH).
Patients and Methods:
Our study was conducted at Assiut University Hospital's Clinical Oncology Department from 2015 to 2019. The study was approved by the Ethical Committee at the Faculty of Medicine, Assiut University (IRB17101267). Data were extracted from the medical records of 36 patients with pathologically confirmed MIBC (cT2- T4a N0M0) treated by 3 cycles of NAC (cisplatin/gemcitabine); responders underwent maximum transurethral resection of the bladder tumor (MTURBT) followed by chemoradiotherapy (60-66 Gy) over 6-weeks with concurrent weekly cisplatin at 40 mg/m2.
Results:
The mean age was 61, with a male predominance of (92%). Smoking was the most common risk factor (72%). 53% were Stage III, followed by (47%) Stage II. Evaluation of treatment response in 29 patients with an overall response rate of (76%); recurrence was observed in (24%), mainly distant recurrence in (17%).
The most common adverse events of NAC were grade 1 and 2 bone marrow suppression in (46%) of patients, followed by gastrointestinal disorder in (33%).
In CCRT, less treatment toxicity was observed, mainly grade 1-2 gastrointestinal disorders (42%), followed by cystitis (41%).
Median DFS was 37 months, and the significant prognostic variables for DFS in a multivariate analysis were patients aged≥65 (HR=9.9) and non-responders to treatment (HR=7). The median overall survival (OS) was 48 months. Significant prognostic variables included patient age ≥65 (HR=19.4) and non-responders to treatment (HR=5).
Conclusion:
NAC, followed by CCRTH, seems to be a promising treatment option for patients under 65 years of age, responders to treatment who refuse surgery or are medically unfit.