Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

The high frequency of cancer bladder among Egyptian patients is related to Bilharzial infestation. Organ confined muscle invasive bladder cancer should be theoretically cured by cystectomy but unfortunately many patients have progressive disease even after apparent radical ablation. Therefore, identification of independent prognostic factors has potential clinical importance, as it can be used to define an individual's risk for tumor progression and to customize appropriate management strategies. Bcl-XL is one of the most important anti-apoptotic members of Bcl-2 family. As few studies have reported a connection between the Bcl-XL expression and bladder cancer, this work is done to verify the relation between Bcl-XL and Bilharzial related bladder cancer, determine its prognostic value and find any correlation between Bcl-XL expression and the pathological prognostic parameters. Also, to show its value as a radio-sensitivity marker. The present study included 100 cystectomy specimens obtained from patients with muscle invasive Bilharzial related bladder cancer who underwent radical cystectomy in the South Egypt Cancer Institute and the Department of Urology at Assiut University Hospital. Those patients were followed either for 2 years after cystectomy or until local recurrence or distant metastasis had occurred. Bcl-XL expression in the tissue specimens detected by immunohistochemical staining was correlated with; the 2 year recurrence-free survival rate, clinicopathological parameters (tumor type, stage, grade, gross picture & regional lymph node infiltration) and response to adjuvant radiotherapy. There was a statistically highly significant negative strong correlation between Bcl-XL expression and the recurrence-free survival (p0.0001 & r = - 0.731) and the response to adjuvant radiotherapy (p0.0001 & r = -0.741). These correlations were stronger in transitional cell carcinoma than in squamous cell carcinoma. A statistically highly significant positive correlation between Bcl-XL expression and tumor grade & iliac lymph nodes infiltration was detected (p = 0.006 & r = 0.271 and p = 0.003 & r = 0.354 respectively). Rabab M. H. El Ghorori et al,. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ There was a statistically significant correlation between the histopathological tumor type and the Bcl-XL expression which was more in transitional cell carcinoma (p = 0.027 & r = 0.226). There was no statistically significant correlation between Bcl-XL and either tumor stage, tumor size or shape. In conclusion, Bcl-XL expression is a highly significant negative prognostic factor in patients with bilharzial-related bladder cancer and it is a highly significant indicator of radio-resistance. Bcl-XL is significantly correlated to regional lymph nodes infiltration, tumor grade and type.

The high frequency of cancer bladder among Egyptian patients is related to Bilharzial infestation. Organ confined muscle invasive bladder cancer should be theoretically cured by cystectomy but unfortunately many patients have progressive disease even after apparent radical ablation. Therefore, identification of independent prognostic factors has potential clinical importance, as it can be used to define an individual's risk for tumor progression and to customize appropriate management strategies. Bcl-XL is one of the most important anti-apoptotic members of Bcl-2 family. As few studies have reported a connection between the Bcl-XL expression and bladder cancer, this work is done to verify the relation between Bcl-XL and Bilharzial related bladder cancer, determine its prognostic value and find any correlation between Bcl-XL expression and the pathological prognostic parameters. Also, to show its value as a radio-sensitivity marker. The present study included 100 cystectomy specimens obtained from patients with muscle invasive Bilharzial related bladder cancer who underwent radical cystectomy in the South Egypt Cancer Institute and the Department of Urology at Assiut University Hospital. Those patients were followed either for 2 years after cystectomy or until local recurrence or distant metastasis had occurred. Bcl-XL expression in the tissue specimens detected by immunohistochemical staining was correlated with; the 2 year recurrence-free survival rate, clinicopathological parameters (tumor type, stage, grade, gross picture & regional lymph node infiltration) and response to adjuvant radiotherapy. There was a statistically highly significant negative strong correlation between Bcl-XL expression and the recurrence-free survival (p0.0001 & r = - 0.731) and the response to adjuvant radiotherapy (p0.0001 & r = -0.741). These correlations were stronger in transitional cell carcinoma than in squamous cell carcinoma. A statistically highly significant positive correlation between Bcl-XL expression and tumor grade & iliac lymph nodes infiltration was detected (p = 0.006 & r = 0.271 and p = 0.003 & r = 0.354 respectively). Rabab M. H. El Ghorori et al,. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ There was a statistically significant correlation between the histopathological tumor type and the Bcl-XL expression which was more in transitional cell carcinoma (p = 0.027 & r = 0.226). There was no statistically significant correlation between Bcl-XL and either tumor stage, tumor size or shape. In conclusion, Bcl-XL expression is a highly significant negative prognostic factor in patients with bilharzial-related bladder cancer and it is a highly significant indicator of radio-resistance. Bcl-XL is significantly correlated to regional lymph nodes infiltration, tumor grade and type.

The high frequency of cancer bladder among Egyptian patients is related to Bilharzial infestation. Organ confined muscle invasive bladder cancer should be theoretically cured by cystectomy but unfortunately many patients have progressive disease even after apparent radical ablation. Therefore, identification of independent prognostic factors has potential clinical importance, as it can be used to define an individual's risk for tumor progression and to customize appropriate management strategies. Bcl-XL is one of the most important anti-apoptotic members of Bcl-2 family. As few studies have reported a connection between the Bcl-XL expression and bladder cancer, this work is done to verify the relation between Bcl-XL and Bilharzial related bladder cancer, determine its prognostic value and find any correlation between Bcl-XL expression and the pathological prognostic parameters. Also, to show its value as a radio-sensitivity marker. The present study included 100 cystectomy specimens obtained from patients with muscle invasive Bilharzial related bladder cancer who underwent radical cystectomy in the South Egypt Cancer Institute and the Department of Urology at Assiut University Hospital. Those patients were followed either for 2 years after cystectomy or until local recurrence or distant metastasis had occurred. Bcl-XL expression in the tissue specimens detected by immunohistochemical staining was correlated with; the 2 year recurrence-free survival rate, clinicopathological parameters (tumor type, stage, grade, gross picture & regional lymph node infiltration) and response to adjuvant radiotherapy. There was a statistically highly significant negative strong correlation between Bcl-XL expression and the recurrence-free survival (p0.0001 & r = - 0.731) and the response to adjuvant radiotherapy (p0.0001 & r = -0.741). These correlations were stronger in transitional cell carcinoma than in squamous cell carcinoma. A statistically highly significant positive correlation between Bcl-XL expression and tumor grade & iliac lymph nodes infiltration was detected (p = 0.006 & r = 0.271 and p = 0.003 & r = 0.354 respectively). Rabab M. H. El Ghorori et al,. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ There was a statistically significant correlation between the histopathological tumor type and the Bcl-XL expression which was more in transitional cell carcinoma (p = 0.027 & r = 0.226). There was no statistically significant correlation between Bcl-XL and either tumor stage, tumor size or shape. In conclusion, Bcl-XL expression is a highly significant negative prognostic factor in patients with bilharzial-related bladder cancer and it is a highly significant indicator of radio-resistance. Bcl-XL is significantly correlated to regional lymph nodes infiltration, tumor grade and type.

The high frequency of cancer bladder among Egyptian patients is related to Bilharzial infestation. Organ confined muscle invasive bladder cancer should be theoretically cured by cystectomy but unfortunately many patients have progressive disease even after apparent radical ablation. Therefore, identification of independent prognostic factors has potential clinical importance, as it can be used to define an individual's risk for tumor progression and to customize appropriate management strategies. Bcl-XL is one of the most important anti-apoptotic members of Bcl-2 family. As few studies have reported a connection between the Bcl-XL expression and bladder cancer, this work is done to verify the relation between Bcl-XL and Bilharzial related bladder cancer, determine its prognostic value and find any correlation between Bcl-XL expression and the pathological prognostic parameters. Also, to show its value as a radio-sensitivity marker. The present study included 100 cystectomy specimens obtained from patients with muscle invasive Bilharzial related bladder cancer who underwent radical cystectomy in the South Egypt Cancer Institute and the Department of Urology at Assiut University Hospital. Those patients were followed either for 2 years after cystectomy or until local recurrence or distant metastasis had occurred. Bcl-XL expression in the tissue specimens detected by immunohistochemical staining was correlated with; the 2 year recurrence-free survival rate, clinicopathological parameters (tumor type, stage, grade, gross picture & regional lymph node infiltration) and response to adjuvant radiotherapy. There was a statistically highly significant negative strong correlation between Bcl-XL expression and the recurrence-free survival (p0.0001 & r = - 0.731) and the response to adjuvant radiotherapy (p0.0001 & r = -0.741). These correlations were stronger in transitional cell carcinoma than in squamous cell carcinoma. A statistically highly significant positive correlation between Bcl-XL expression and tumor grade & iliac lymph nodes infiltration was detected (p = 0.006 & r = 0.271 and p = 0.003 & r = 0.354 respectively). Rabab M. H. El Ghorori et al,. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ There was a statistically significant correlation between the histopathological tumor type and the Bcl-XL expression which was more in transitional cell carcinoma (p = 0.027 & r = 0.226). There was no statistically significant correlation between Bcl-XL and either tumor stage, tumor size or shape. In conclusion, Bcl-XL expression is a highly significant negative prognostic factor in patients with bilharzial-related bladder cancer and it is a highly significant indicator of radio-resistance. Bcl-XL is significantly correlated to regional lymph nodes infiltration, tumor grade and type.

The high frequency of cancer bladder among Egyptian patients is related to Bilharzial infestation. Organ confined muscle invasive bladder cancer should be theoretically cured by cystectomy but unfortunately many patients have progressive disease even after apparent radical ablation. Therefore, identification of independent prognostic factors has potential clinical importance, as it can be used to define an individual's risk for tumor progression and to customize appropriate management strategies. Bcl-XL is one of the most important anti-apoptotic members of Bcl-2 family. As few studies have reported a connection between the Bcl-XL expression and bladder cancer, this work is done to verify the relation between Bcl-XL and Bilharzial related bladder cancer, determine its prognostic value and find any correlation between Bcl-XL expression and the pathological prognostic parameters. Also, to show its value as a radio-sensitivity marker. The present study included 100 cystectomy specimens obtained from patients with muscle invasive Bilharzial related bladder cancer who underwent radical cystectomy in the South Egypt Cancer Institute and the Department of Urology at Assiut University Hospital. Those patients were followed either for 2 years after cystectomy or until local recurrence or distant metastasis had occurred. Bcl-XL expression in the tissue specimens detected by immunohistochemical staining was correlated with; the 2 year recurrence-free survival rate, clinicopathological parameters (tumor type, stage, grade, gross picture & regional lymph node infiltration) and response to adjuvant radiotherapy. There was a statistically highly significant negative strong correlation between Bcl-XL expression and the recurrence-free survival (p0.0001 & r = - 0.731) and the response to adjuvant radiotherapy (p0.0001 & r = -0.741). These correlations were stronger in transitional cell carcinoma than in squamous cell carcinoma. A statistically highly significant positive correlation between Bcl-XL expression and tumor grade & iliac lymph nodes infiltration was detected (p = 0.006 & r = 0.271 and p = 0.003 & r = 0.354 respectively). Rabab M. H. El Ghorori et al,. ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ There was a statistically significant correlation between the histopathological tumor type and the Bcl-XL expression which was more in transitional cell carcinoma (p = 0.027 & r = 0.226). There was no statistically significant correlation between Bcl-XL and either tumor stage, tumor size or shape. In conclusion, Bcl-XL expression is a highly significant negative prognostic factor in patients with bilharzial-related bladder cancer and it is a highly significant indicator of radio-resistance. Bcl-XL is significantly correlated to regional lymph nodes infiltration, tumor grade and type.

Bakground: This study was conducted to test the efficacy and tolerability of trimodality treatment for invasive bladder cancer and to test the possibility of bladder sparing. Methods: This study had been carried out on 50 patients with transitional cell carcinoma (TCC) stage T2T3 tumors with adequate performance status and renal function. All patients were subjected to maximum transurethral resection of bladder tumors (TURBT). Patients were then subjected to chemo-radiation that was executed in two treatment phases. Phase I was external radiotherapy in the form of 46 Gy /23 fractions /5 weeks to whole pelvis with concurrent cisplatin 40 mg/m2 weekly. Phase II was 20 Gy /10 fractions /2 weeks to the bladder tumor with concurrent cisplatin 40 mg/m2 weekly. After phase I, patients who had complete response (CR) or partial response (PR) were subjected to phase II and patients who had stationary disease (SD) were subjected to salvage cystectomy. After the end of treatment, patients who had CR were subjected to bladder preservation. Radiological and cystoscopic reevaluation was done to assess the tumor response after phase I and phase II. After completion of the scheduled treatment, patients were under follow up for clinical examination, radiological, and cystoscopic assessment. Results: The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of treatment. Bladder preservation was achieved in 72% of patients. The actuarial relapse free survival and overall survival at a median follow up 18 months for patients who were candidate for bladder preservation were 81% and 100%; respectively. Invasive recurrence (16%) salvaged with cystectomy and superficial recurrence (6%) successfully treated with Bacilles bilie de CalmetteGuerin. Conclusions: This study indicates that in spite of a relatively small number of patients and short follow-up period; the trimodality treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance.