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Introduction:
The incidence and optimal management of NMIBC recurrences after combined-modality therapy (CMT) for MIBC remains unclear. We sought to describe the incidence, management and outcomes of NMIBC recurrences in complete responders (CR) after CMT.
Materials & Methods:
333 patients with cT2-4aN0M0 MIBC who had a CR after CMT were reviewed retrospectively (1986-2012). Patients underwent concurrent chemotherapy and radiation therapy (chemoRT) after maximal transurethral resection of bladder tumor (TURBT). CRs, defined as those with a negative biopsy after 40 Gy RT, received boost chemoRT.
Results:
A total of 70 (21%) CRs developed NMIBC with a mean follow-up of 9.3 years. Median time to first NMIBC recurrence was 18 months (range 4-250). 20 (92%) NMIBC recurrences were considered “high risk” (HR) defined as cTaG2/G3, CIS, or T1. Treatment of first recurrence included TURBT alone (40%), TURBT/BCG (49%), TURBT/intravesical chemotherapy (6%), or radical cystectomy (6%). Among HR recurrences, 59% were treated with BCG and had no further recurrences. 68% of all patients who received BCG completed induction with minimal toxicity. The expected lifetime chance of recurrence after surviving 10 years without any recurrence was 20%. 5- and 10-year DSS for CRs without recurrences (81% and 79%, respectively) was comparable to those with NMIBC recurrences (84% and 77%, respectively) (p=0.8).
Conclusions:
NMIBC recurrences can occur beyond a decade after CMT. NMIBC recurrences may be treated successfully with BCG and tolerability is comparable to that of non-radiated patients. DSS for patients with NMIBC recurrences after CMT is comparable to those without recurrences.