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Purpose/Objective(s): Trimodality therapy (TMT) is an effective and appealing alternative for bladder preservation in selected patients with muscle invasive bladder cancer (MIBC). Cisplatin has been frequently used as a radiosensitizer. However, in this usually elderly population with compromised renal function, the use of cisplatin may not be always feasible. We report results of hypofractionated IMRT (HypoIMRT) and weekly gemcitabine as components of a TMT regimen for patients with MIBC.
Materials/Methods: From June 2008 to June 2017, 49 patients with T2-3N0M0 bladder cancer underwent treatment with HypoIMRT with concomitant weekly gemcitabine following maximal transurethral resection of bladder tumor (TURBT). HypoIMRT delivered a dose of 50 Gy in 20 fractions to the whole empty bladder and 40 Gy to pelvic nodes in the same 20 fractions. Weekly gemcitabine at a dose of 100 mg/m2 was given concomitantly. Patients treated with neoadjuvant chemotherapy or those treated with another chemotherapy agent were not included. Response rate was assessed by cystoscopy evaluation and bladder biopsy.
Results: The median age was 76 years (range: 58-91). A complete TURBT was achieved in 90% of patients. A complete response post-therapy was confirmed in 88% of the patients. At a median follow-up of 20 months, 20 patients had died, 10 of them from bladder cancer. Of those patients achieving a complete response, 29 patients (67.5%) have remained disease-free at a median follow-up of 21 months. The median time for either local or distant failure was 12 months. 8 patients (16%) failed in the bladder only (5 with superficial and 3 with invasive disease) with an actuarial local control projection of 75% at 3 years. Of the 8 patients failing locally, 3 of them presented with hydronephrosis and 2 had an incomplete TURBT; 13 patients (26.5%) failed distantly. The 3- and 5-year cancer-specific survival rate was 77%. Treatments were well tolerated with all patients completing HypoIMRT and 78% completing 4 cycles of gemcitabine. Grade 3 acute GU or GI toxicity was seen in 2% of patients (no grade 4 or 5). Late grade 2 or higher GI or GU toxicity was seen in 2% and 6%, respectively (no grade 4 or 5).
Conclusion: HypoIMRT plus concurrent weekly gemcitabine post-TURBT is an effective, feasible and well-tolerated curative treatment strategy in selected patients with MIBC.
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