PD55-04: Non-muscle Invasive Bladder Cancer Recurrences in patients Managed with Trimodal Therapy: Conservative or radical treatment?

Khaled Ajib, Mohammad Baker Berjaoui , Jaime O. Herrera Caceres, Michael C Tjong, Gregory Nason, Annette Erlich, Srikala Sridhar, Neil Fleshner, Alexandre Zlotta, charles Catton, alejandro Berlin, Peter Chung, Girish Kulkarni

Introduction: Although radical cystectomy is the mainstay of treatment in patients with localized, muscle-invasive bladder cancer (MIBC), bladder preservation with trimodal therapy (TMT) has emerged as a feasible alternative. With TMT the preserved bladder remains at risk for local recurrence; however, a consensus on the treatment approach in case of recurrence is yet to be established. This is the first study to evaluate whether recurrences of non-muscle invasive bladder cancer after receiving TMT are best managed with radical or conservative therapies.

Methods: We retrospectively analyzed our bladder preservation, TMT database and identified all patients with recurrent non-muscle invasive bladder cancer between 2003-2018. Patients were treated with maximal TURBT followed by combination chemotherapy/radiotherapy (weekly cisplatin 40 mg/m2 and 64-66 Gy to the bladder) with localizing Lipiodol injections. We compared those patients to a cohort of matched controls with primary de-novo NMIBC. Those patients were derived from our local NMIBC database and matching was based on clinical stage and grade in a 6:1 manner (controls:cases). Recurrences in the TMT group were managed according to the standard therapy for NMIBC. A descriptive analysis was performed between patients undergoing TMT with NMIBC recurrence and patients initially diagnosed with de novo NMIBC. Overall survival, recurrence-free, and cystectomy-free survival were calculated for each group and analyzed using the Kaplan-Meier method.

Results: From the TMT cohort, only 9 patients out of 124 had NMIBC recurrence and were matched to 54 de-novo NMIBC patients as a control group. Median age of the TMT group was 72.4 years versus 66 years for the non-TMT group. Median follow-up for both groups was 3.8 years. The 9 recurrences within the TMT group had the following clinical staging: cTa (3 patients), cT1 (3 patient), and CIS (3 patients). During the follow-up period, the total number of recurrences was 24% (13/54) in the non-TMT group compared to 11.1% (1/9) in the TMT group (p=0.32). No patient from the TMT group required a cystectomy as compared to 16.7% (9/54) in the non-TMT group (p=0.36). Overall survival was 77.8% (7/9) in TMT group compared to 100% in non-TMT group (p<0.001), knowing that the Disease-Specific Survival in the TMT group is 100%.

Conclusions: We have demonstrated that NMIBC recurrences post TMT can be successfully managed with endoscopic and adjuvant intravesical therapies, with outcomes similar to de novo NMIBC patients of the same stage and grade. These results provide guidance for patients and providers who elect TMT for localized MIBC. Source of

Funding: None