Purpose: To update long-term results with selective organ preservation in invasive bladder cancer using
aggressive transurethral resection of bladder tumor (TURBT) and radiochemotherapy (RCT) and to identify
prognostic and predictive value of the biomarkers ;p53, pRB, BCL2 and EGFR.
Patients and Methods: Between 2000 and 2006, a total of 55 patients with T2-T3 bladder cancer were
enrolled in 2 sequential bladder-sparing protocols including aggressive TURB and RCT. From September
2000 to May 2003, 25 patients (in protocol no. 1) were treated by TURBT followed by radiotherapy 46 Gy
with concurrent cisplatin 20 mg/m² day1-5, followed for complete and partial responders by radiotherapy 20
Gy with concurrent cisplatin (same dose) on the last five days. From December 2004 to April 2006, thirty
patients were entered in protocol no. 2 that consisted of radiotherapy 60 Gy with concurrent Cisplatin 75 mg/
m2 q. 3 ws and Gemcitabine 300 mg / m2 D 1, 8 and 15 q. 3 ws for 2 cycles. In case of invasive residual
tumor or recurrence, salvage cystectomy was recommended. All specimens were examined for expression of
the biomarkers (p53, bcl2, Rb and EGFR) using immunohistochemical staining.
Results: The median follow-up for all patients is 30 months (range 4–84), 38 months (range 9– 84) for patients
in P1 and 22 months (4–54) for patients in P2. The actuarial 5-year OS were 58 % (SE 5), 52% (SE 7) and
61% (SE 6),for the whole series, P1 and P2 protocols respectively, (P =0.270). The corresponding figures for
cancer specific survival (CSS) were 60%, 55% (SE 7) and 63% (SE 4), (P = 0.452). The 5-year actuarial OSB
for all series, P1 and P2 protocols were 51% (SE 6), 46% (SE 7) and 55% (SE 9), respectively, (P = 0.323). For
all patients, altered expression of p53, bcl2, pRb and EGFR were detected in (47.3%, 56.4%, 52.7% and 40%
respectively The results of UVA showed that tumor stage and altered expression of pRB, BCL2 and EGFR
were significantly associated with CSS and OS (P<0.05). There were no grade 4 toxicity and no treatmentrelated
deaths.
Conclusion: Trimodality therapy to preserve the bladder is a therapeutic option that results in a high rate of
long-term survivors retaining functional bladders in carefully selected patients. Patients with higher tumour
stage and altered biomarkers; pRB, BCL2 and EGFR might not be candidate for bladder preserving approach.