Combined-Modality Treatment for High Risk TCC of the Bladder

Objective To identify the ideal therapy for high risk bladder cancer with good survival and quality. Methods Between January 1997 and November 2006, 111 patients (86 males and 25 females) with histologically confirmed transitional cell carcinoma were enrolled. Median age was 61 years (range,37-78 years). 45 patients had T1G3 lesions (included multiple,8; recurrence, 16). 66 had T2, T3, and T4. All patients underwent complete transurethral resection of the bladder tumor (TURBT), partial cystectomy and radical cystectomy at our institution. 3 circles systemic chemotherapy with MVAC modality were given 4 weeks after operations. Intravesical adjuvant chemotherapy (epirubicin 50 mg) was followed monthly up to 2 years postoperatively. Bilateral arterial infusion of antitumor drugs monthly for 3 circles were kept only for multiple, recurrent and locally advanced tumors. Results 90 patients were followed up for 39.2 months (12-60 months). The 2 years recurrence rate is 30% (27/90). The overall survivals are 77.8% at 3 year and 62.2% at 5 years, respectively. Conclusion TURBT, partial or total cystectomy could be choosed for bladder tumors of T₁G₃, multiple, recurrenced and T2-T4 to achieve complete resection of tumor, followed by arterial or systemic chemotherapy early after operation and intravesical chemotherapy for up to 2 years. It is an effective treatment for high risk bladder cancer, with reduction in tumor recurrence and improvement in survival with good quality life.