Abstract

Assessment of Outcome and Feasibility of Bladder Preservation Therapy in Muscle Invasive Bladder Carcinoma: A Prospective Observational Study with Meta-analysis

Background: Radical Cystectomy (RC) is the standard of care for the management of Muscle Invasive Bladder Cancer (MIBC). Considering perioperative complications coupled with a classically older patient population with multiple comorbidities has led patients and clinicians to seek alternatives to cystectomy like organ-preserving therapies in the management of bladder cancer over the past several decades. Objectives: The primary objectives were to assess the outcome (overall survival, recurrence-free survival) of bladder preservation therapy in patients with muscle invasive bladder carcinoma and to compare the outcome of bladder preservation therapy with the outcome of radical cystectomy in patients with muscle invasive bladder carcinoma. Methods: In a prospective observational setting patients with clinical stage T2-T4aN0M0 (after initial cystoscopic biopsy) carcinoma of the urinary bladder were given a choice between bladder preservation therapy (Only maximal TURBT/Partial cystectomy/Hemicystectomy/ Primary chemotherapy/Primary Radiotherapy/Concurrent Chemo-radiation) and radical cystectomy. The decision to pursue bladder preservation therapy was based on the patient’s choice after a multidisciplinary discussion of treatment options. Primary endpoints were overall survival, recurrence-free survival, disease-specific survival, bladder intact survival, and secondary endpoints considered were-tumor response, treatment compliance, and rate of salvage radical cystectomy, toxicity, and patient-reported quality of life. Results: Out of 116 patients with MIBC enrolled in the study, 31 (26.7%) opted for Radical Cystectomy (RC) while the rest 85 patients (73.3%) opted/considered bladder preservation therapy. The majority (70%) of patients with muscle invasive bladder carcinoma chose or was suitable to undergo bladder preservation therapy and the rest (30%) chose or were suitable to undergo radical cystectomy. In the bladder preservation therapy group, the majority (82.2%) of patients underwent chemo-radiation after TUR biopsy, 4.1% of patients underwent partial cystectomy and 13.7% of patients underwent maximal (radical) TURBT followed by chemo-radiation. Overall survival, recurrence-free survival, disease-specific survival, and bladder intact survival in the bladder preservation therapy group at 22 months follow-up (Median follow-up period-11.97 months) were 80.8%, 56.2%, 84.9%, and 75.3% respectively. Conclusions: Survival of bladder preservation therapy patients was non-inferior to the survival of radical cystectomy patients at 22 months follow-up. Mortality and morbidity of bladder preservation therapy were acceptable.

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