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