Introduction and objectives: Radical cystectomy is the standard of care for muscle-invasive bladder cancer (MIBC). Multimodal bladder preserving treatment (MMT), which combines transurethral resection of the bladder (TURB), chemotherapy and radiotherapy (RT), may be an option for well-informed patients who refuse radical surgery or for those unfit for cystectomy. The aim of our study is to evaluate the oncological outcomes of patients treated with MMT in our institution.

Material and Methods: Retrospective evaluation of the electronic medical records (EMR) of all pts diagnosed with MIBC who underwent MMT in Hospital Beatriz Ângelo, from 2012 to 2019. Statistical analysis was performed with the use of SPSS version 24.

Results: A total of 16 patients (pts) were included, with a median age of 76 [59;85] years-old (yo), 94% being males. Fourteen pts were initially diagnosed with MIBC and two progressed from non-muscle invasive disease. Six patients were unfit for platinum-based chemotherapy regimens, and were treated with 5-fluorouracil plus mitomycin. Four patients discontinued chemotherapy due to hematological toxicity. After a median follow-up of 36,7 months [10,2;82], there were 8 deaths, 4 of which disease-related. Two pts developed metastatic disease. The median overall survival (OS) was 68,3 months [95%CI: 10,7 – 125,9].

Conclusion: As tends to occur in most centers, all our patients selected for MMT were unfit for radical surgery. In spite of being a small cohort of patients, we found encouraging results, with only four disease related deaths over a median period of  36,7 months. Evaluating real-life outcomes may contribute to a better selection of patients for bladder sparing treatments, eventually allowing us to expand its indications for frail patients with a small burden of disease.

Real-life experience in multimodal bladder preserving treatment for muscle-invasive bladder cancer