Doğan BAYRAM, Öznur BAL, Alper TÜRKEL, Serhat SEKMEK, Emre HAFIZOĞLU, Berkan KARABUĞA, Mutlu DOĞAN, Efnan ALGIN, Doğan UNCU
The European Research Journal - 2026;12(2):160-172
Objectives: Radical cystectomy following neoadjuvant chemotherapy is the standard treatment for Muscle-Invasive Bladder Cancer (MIBC). However, definitive chemoradiotherapy may represent a viable alternative in patients who are medically inoperable or decline surgery. This study aimed to compare the clinical outcomes of patients with stage II-III MIBC treated with neoadjuvant chemotherapy followed by either Radical cystectomy or CRT, the latter performed without maximal transurethral resection of bladder tumor (TURBT). Methods: This retrospective study included 63 patients with stage II-III MIBC treated between December 2014 and March 2025 at two tertiary referral centers in Türkiye. All patients received neoadjuvant chemotherapy (NAC) prior to either surgery (n=39) or Chemoradiotherapy (CRT) (n=24). Clinicopathological, laboratory, and survival data were analyzed. Results: The median age was 64 years, and 88.9% of patients were male. Median OS was 46.5 months in the surgery group and 31.6 months in the CRT group (P=0.407), while median EFS was 30.1 and 21.0 months, respectively (P=0.375). Multivariate analysis identified comorbidity and hemoglobin <12 g/dL as independent predictors of poor survival. Conclusions: NAC followed by either surgery or CRT provides comparable long-term disease control in patients with stage II-III MIBC. Although RC remains the gold standard for operable patients, CRT offers an effective curative-intent option for those unfit for surgery-even in the absence of maximal TURBT.
