Locally Advanced Bladder Cancer: A Case for Combined Chemotherapy and Radiotherapy

By Dr Tay Miah Hiang, Associate Consultant
Dept of Medical Oncology, NCC

A 70 year old man was seen at the National Cancer Centre with locally advanced bladder cancer with associated obstruction to both kidneys. Radical surgery is usually a big undertaking with poor result and comes with operative risk. Therefore, it is generally not recommended.

Figures: CT scan showing the thickened bladder wall that has been invaded by the cancer and the enlarged kidneys as a result of obstruction of the ureters that drains the urine from the kidneys to the bladder.

To relieve obstruction to the kidneys, a tube was inserted into both kidneys so that urine may be drained out to an external urinary bag. Subsequently, the patient underwent concurrent chemotherapy and radiotherapy as an outpatient. The patient tolerated the treatment well and at the end of treatment, both tubes in the kidneys were removed. A bladder biopsy was performed 6 months later and there was no evidence of cancer.

This case demonstrated the feasibility of a combined treatment of chemotherapy and radiotherapy in a patient with a locally advanced bladder cancer especially when surgery is not feasible. Although the follow-up of this patient is rather short (8 months), the first objective of safe treatment and one that is able to induce a complete remission (no evidence of disease) has been achieved. A longer follow-up time will determine whether the disease will recur or not.