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What happens to the patients with muscle-invasive bladder cancer who refuse cystectomy after neoadjuvant chemotherapy
Indian Journal of Urology, 06/29/09

Maheshwari R et al. - Study highlights the fact that patients with muscle-invasive bladder cancer refusing cystectomy after chemotherapy are at high risk for disease-related mortality. At the same time, pts with small, clinically confined single tumors, which can be visibly and microscopically completely resected before neoadjuvant chemotherapy, are most likely to survive without cystectomy.

• A prospective study to determine the outcome of pts who refuse cystectomy after receiving neoadjuvant chemotherapy
• 63 such pts evaluated between 1995-2001
• Tumor and treatment features for a median f/u of 86 mo was assessed, all pts being followed-up for >5 yrs

• 40 pts (64%) survived, with 54% of them having an intact functioning bladder
• The number and size of invasive tumors were strongly associated with overall survival
• The most significant treatment variable predicting better survival was complete resection of the invasive tumor on restaging transurethral resection (TUR) before starting chemotherapy
• Of 23 pts (36%) who subsequently died of disease, 19 (30%) relapsed with invasive cancer in bladder
• Over 90% of the surviving pts had solitary, small and low-stage invasive tumors completely resected; 83% survived w/o relapses in the bladder

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