Authors: Salil Vengalil, Tamseel Fatima, Loaie ElHelw , Lyndon Gommersall, Samson Liu, Shibu Joseph, Rajanee Bhana 
University Hospital North Midlands NHS Trust, Stoke on Trent, UK

Background 
Bladder cancer is the 10th most common cancer in the UK with over 10,000 new cases diagnosed every year. Neo-adjuvant chemotherapy (NAC) has an established role in the multi-modal treatment approach for muscle invasive bladder cancer (MIBC). BC2001 trial have shown significant improvement in loco-regional control and reduced rate of salvage cystectomy with concurrent chemo-radiotherapy (CRT). BCON trial have also reported improved disease control with use of concurrent hypoxia modifiers with radical radiotherapy (RT) in similar settings. NICE and ESMO guidelines have recommended combining radio sensitising agents with radical doses of RT.

Methods 
We conducted a retrospective audit of MIBC patients treated with radical intent in our institution over a period from January 2012 to December 2016. We analysed treatment outcomes and proportion of patients receiving recommended standard of care treatments.

Results 
There were 104 patients with MIBC treated with radical intent during this time period. Average age at diagnosis was 69.3 years and 75% were males. Vast majority of patients had urothelial carcinoma.
Primary radical cystectomy was performed in 8 patients. NAC was given to 72% of patients, with over 90% of these patients receiving cisplatin gemcitabine chemotherapy. Bladder preserving treatments were given to nearly 70% of patients and over half of these patients received CRT and remaining were treated with RT alone. Mitomycin plus 5-FU and gemcitabine were the most commonly used concurrent chemotherapy regimens. Treatment was reasonably well tolerated and febrile neutropenia rate was only 4%. 
Relapse occurred in 40% of patients and majority of these were distant metastases. Local recurrence was observed in about 18% patients treated with bladder preserving approach and only 30% of these were suitable for salvage cystectomy. About 28% of patients who remained free of recurrence died due to other co-morbidities.

Conclusions 
Multi-modal treatment approach was used in majority of patients with comparable treatment outcomes to published data. Utilisation of radio-sensitising agents could be improved. Significant proportion of patients died due to other causes, indicating existence of multiple comorbidities in this population.

Multi-modal treatment approach for muscle invasive bladder cancer - single institution experience