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Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy is the gold standard for the treatment of muscle-invasive bladder Ca. However, the gold standard may not be the best treatment for individual patients. The alternative best treatment option is the bladder sparing tri-modality treatment in which surgery (maximal TURBT) is followed by definitive chemoradiation therapy with the intent of cure along with organ preservation.

Our primary objective includes the estimation of the overall survival and disease-free survival at 3 and 5 years in patients of bladder cancer treated with a bladder preservation approach at a dedicated cancer institute. Secondary objectives include the outcome of different radiation fractionation, induction chemotherapy and time to radiation after TURBT.

After taking IRB approval, 91 patients of bladder cancer treated with curative intent and bladder preservation approach, between January 2010 till December 2018 were retrospectively reviewed. Demographic characteristics and details of all procedures including surgery (TURBT), chemotherapy and radiation therapy were documented with the help of the Hospital Information System. Treatment response and follow-up details were documented according to notes.   

The median age was 63 (range 28-84). 89% (n=80) were male. Out of 91 patients, 53 (58%) patients had T3 disease and 32 (35%) of the patients had node-positive disease. Induction chemotherapy was given in 43 patients (47.3 %) after TURBT. 78 (85.7%) patients received concurrent chemotherapy with radiation therapy. Hypo-fractionated radiation therapy (55Gy in 20 fractions) was given in 50 patients (54.9%). Overall survival was found to be 77% and 62% and DFS was 62% and 51% at 3 and 5 years respectively. Induction chemotherapy had no significant impact on OS. However, OS was estimated to be higher in those patients in which radiation therapy was started within 6 weeks of TURBT and in those patients who received hypofractionated radiotherapy.

Our study shows that bladder preservation therapy is an effective approach that can be the best treatment in selected patients with Bladder Ca.  Overall survival at 3 and 5 years in patients treated with bladder preservation approach at our institute is comparable to the standard of care (radical cystectomy). We recommend case discussion in a Multidisciplinary site-specific tumour board which is important and necessary for offering organ preservation to the bladder ca patients.