As an alternative to radical cystectomy (RC), tri-modality treatment (TMT) is an effective treatment approach for selected patients with muscle-invasive bladder cancer (MIBC). The purpose of this report is to contribute to the literature by summarizing institutional outcomes of a bladder-preserving TMT approach for patients with MIBC.

Patients treated with TMT for MIBC from 1998-2019 were identified. Patient, disease, and treatment factors were recorded. Overall survival (OS), disease-free survival (DFS), and bladder-preserved disease-free survival (bpDFS) were estimated with the Kaplan-Meier method. Prognostic factors were evaluated with Cox proportional hazards regression.

Thirty-two patients treated with TMT to a median dose of 64.8Gy, for T2 (78%), T3 (19%) and T4 (3%) disease were followed for a median of 19 months (mean: 36, range 6 – 213); 31% had associated carcinoma-in-situ (CIS); 25% had associated hydronephrosis. Cisplatin was the most commonly used chemotherapeutic agent. OS rates were 84% at 1-yr and 61% at 5-yrs. DFS rates were 84% and 61% and bpDFS rates were 84% and 60% at 1-yr and 5-yrs, respectively. Salvage cystectomy rates at 1- and 5-yrs were 4% and 9%, respectively. Four patients had locally invasive recurrences at 8, 11, 34, and 37 months after initial MIBC diagnosis, two of whom underwent salvage radical cystectomy. Ten (31%) patients developed distant disease at a median of 13 months after diagnosis. Unlike local recurrence, distant recurrences were associated with worse OS, hazard ratios of 3.4 (p.=0.039)

OS and DFS were comparable to those of published data. Our outcomes support TMT as an effective option for carefully selected patients with MIBC.

In this series, we summarize the bladder preserving/trimodality treatment experiences at our institution in hopes of contributing to the literature. Our institutional experience with bladder preservation confirms previously reported oncologic control rates with 5-year DFS and OS of 61% (95% CI: 37 – 77%) and 61% (95% CI: 38 – 77%), despite a higher risk population comprising many patients with T3+ disease and/or incomplete TURBT. Trimodality treatment is underutilized as a viable radiation-based organ preservation approach.