Presentation Authors: Masahiro Toide*, Toshiki Kijima, Shohei Fukuda, Hiroshi Fukushima, Shingo Moriyama, Sho Uehara, Yosuke Yasuda, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Kazunori Kihara, Yasuhisa Fujii, Tokyo, Japan
Introduction: Trimodality bladdersparing therapy has become an accepted treatment for selected patients with muscle-invasive bladder cancer (MIBC). As the presence of hydronephrosis may reduce complete response rate as well as survival in trimodality therapy, some investigators deem hydronephrosis as a contraindication for bladdersparing. We have developed a tetra-modality bladder-sparing therapy (TeMT) consisting of maximal transurethral resection (TUR), induction chemoradiotherapy (CRT), and partial cystectomy (PC) (Koga et al, BJU Int 2012). TeMT which enables surgical consolidation of original MIBC site, involving uretero-vesical anastomosis if necessary, may provide more chance of bladder-sparing for patients with hydronephrosis.
Methods: A total of 151 consecutive patients with cT2-3N0M0 MIBC (median age 69, female/male = 33/118, cT2/3 = 100/51) entered tetra-modality bladdersparing protocol. After maximal TUR and CRT (40Gy + cisplatin), response was evaluated by cytology, imaging and tumor-site rebiopsy. Complete responders proceeded to consolidative PC, while radical cystectomy was recommended for others. Extension of ipsilateral intrapelvic ureter in pretreatment computed tomography was graded following the Society for Fetal Urology grading system, then patients with grade 2-3 were classified as with hydronephrosis. Response rate to CRT, MIBC recurrence-free survival and cancer-specific survival (CSS) were compared between patients with or without hydronephrosis.
Results: Hydronephrosis was found in 19 patients (14%), and was associated with lower response rate to CRT (42% in hydronephrosis vs 77% in normal, p=0.03). On an intent-to-treat basis, patients with hydronephrosis (n=19) had lower 5-yr CSS than those without it (n=132) (62% vs 85%, p < 0.01; Fig. A). Among the 106 patients who completed PC on protocol, 24 patients underwent uretero-vesical anastomosis. In the patients on protocol, patients with (n=9) and without hydronephrosis (n=97) had comparable 5-yr MIBS recurrence-free survival (100% vs 97%, p=0.11) and CSS (100% vs 93%, p=0.46; Fig. B).
Conclusions: Patients with hydronephrosis should not necessarily be excluded from tetra-modality bladdersparing therapy.