Background
Retrospective toxicity analysis from Massachusetts General Hospital. 157 consecutive patients with cT2–T4 muscle-invasive bladder cancer treated with bladder-preserving trimodality therapy (TURBT + concurrent cisplatin-based CRT). Analysis focused on late bladder and bowel toxicity using RTOG/LENT-SOMA grading. Median follow-up 6.3 years.
Interventions and follow up
Arm A: Trimodality therapy (TURBT + concurrent cisplatin-based CRT to 64–65 Gy)
Arm B: N/A (single-arm retrospective series)
Primary endpoint: Late GU and GI toxicity (RTOG grade ≥3)
mFollow up: 6.3 year
Arm B: N/A (single-arm retrospective series)
Primary endpoint: Late GU and GI toxicity (RTOG grade ≥3)
mFollow up: 6.3 year
Results
Late grade ≥3 GU toxicity (any): 6.6%
Late grade ≥3 bowel toxicity: 2.5%
Grade ≥3 urinary incontinence: 0.6%
Grade ≥3 hematuria requiring intervention: 3.2%
Bladder contracture: Rare
Late grade ≥3 bowel toxicity: 2.5%
Grade ≥3 urinary incontinence: 0.6%
Grade ≥3 hematuria requiring intervention: 3.2%
Bladder contracture: Rare
Adverse events
Main adverse events: Overall late grade ≥3 toxicity was low. Most common late GU effects were irritative voiding symptoms (grade 1–2) in ~40%. Grade ≥3 GU events were uncommon. Grade ≥3 bowel toxicity was rare (2.5%). Toxicity rates were not significantly higher than reported with radical cystectomy in comparable studies.
Conclusions
Bladder-preserving trimodality therapy is associated with low rates of late severe GU and GI toxicity in long-term survivors, with preserved bladder function in the majority of patients who avoid cystectomy. These findings support the feasibility and acceptable safety profile of organ-preserving treatment for selected MIBC patients.
Key Limitations
Key Limitations: Single-institution retrospective series with selection bias. Toxicity grading is clinician-reported, not patient-reported outcomes. Patients receiving salvage cystectomy are excluded from long-term toxicity analyses, potentially underrepresenting the full toxicity burden. Comparison with cystectomy toxicity is indirect (no contemporaneous control arm).
Clinical Context
This paper directly addresses the concern that bladder preservation with CRT produces worse bladder function than cystectomy with neobladder. The low rates of severe late toxicity support TMT as a patient preference–driven alternative to radical cystectomy, particularly relevant for patients unable or unwilling to undergo surgery.
References
References: Efstathiou JA et al, JCO 2009; PMID: 19636019