Bladder preservation by neoadjuvant chemotherapy followed by concurrent chemoradiation for muscle-invasive bladder cancer

Introduction: In Egypt, bladder cancer (BC) represents about 8.7% of cancers in both sexes. In Egyptian men, it ac-counts for over 30% of all cancers, which makes it the second most fre-quent cancer. The standard curative treatment for patients with muscle -in-vasive bladder cancer (MIBC) has been radical cystectomy (RC) with urinary diversion and pelvic lym phadenec-tomy. Concomitant chemoradiation therapy (CCRT) in MIBC appears to produce results that are comparable to those of RC.Material and methods: Between Jan-uary 2018 and March 2021, 34 BC -diagnosed patients, who refused RC, were enrolled. They received trans -urethral resection of the bladder tu-mour (TURBT) followed by 3 cycles of neoadjuvant chemotherapy (NACT) with gemcitabine, cisplatin, and CCRT. Concomitant chemoradiation therapy with cisplatin, as a chemosensitizer, was administered to patients who experienced a complete response (CR) and a partial response (PR) symbolscript 50%.Results: Following NACT, CCRT was given to 27 patients (79.45%) who had either a PR > 50% or CR. Seven patients (20.5%) showed PR below 50%, stable disease, or progressive disease; 4 of them underwent RC followed by postoperative radiation. The average follow-up period was 46 months (range: 6-52 months). Twenty-three patients (67.6%) were still alive at the last check-up. Disease-free survival and 3-year over-all survival were 70.8% and 65.1%, respectively.Conclusions: Bladder preservation provides survival rates comparable to those of MIBC patients, but with a higher quality of life. The findings show good survival rates without metastasis; nevertheless, more mul-ticentre trials with larger sample sizes and longer follow-up periods are re-quired to confirm these findings.