NON-INVASIVE TREATMENT OF MUSCLE INVASIVE BLADDER CANCER IN PATIENTS WITH DERANGED RENAL PROFILE

Abstract

Objective:

To determine the efficacy of trimodality therapy in patients with muscle invasive carcinoma of the bladder with deranged renal profile.

Study Design: Quasi-experimental study.

Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi over 14 months, from Sep 2015 to Nov 2016.

Patients and Methods:

Forty patients (n=40) having histopathologically confirmed (urothelial) urinary bladder cancer, clinical stage II or III, aged 18 to 80 years, with Eastern Cooperative Oncology Group (ECOG) perfor-mance status ≤2 and having deranged renal functions were included in this study. After maximal transurethral resection of bladder tumour (TURBT), they received 4 courses of chemotherapy with mitomycin and 5 fluorou-racil, followed by concurrent chemoradiation using same chemotherapy received 50 Grays in 20 fractions. Response was assessed using RECIST criteria.

Results:

Efficacy; defined in terms of complete and partial response, was observed in 85% (n=34) of patients. Treatment efficacy was better in males as compared to females (90.6% vs. 62.55: p<0.05). Patients with better ECOG-PS (0-1) and early stage (2) responded well to treatment while response was almost same in different age groups, (p>0.05 in all cases). Thirty-seven patients were able to complete the full study protocol, 2 had severe mucositis and hand-foot syndrome while one patient died after septicaemia.

Conclusion:

Trimodality treatment with TURBT, chemotherapy and chemo-radiation is a feasible option for bladder preservation in muscle invasive bladder cancer patients with compromised renal functions if we use 5-fluorouracil and mitomycin chemotherapy.