Objective To investigate the efficacy and safety of neoadjuvant intensity modulated radiation therapy combined with"complete"transurethral resection of bladder tumor(cTURBT)and adjuvant chemotherapy for the treatment of T2 stage muscle invasive bladder cancer(MIBC)≥3 cm in diameter.Methods A retrospective analysis was performed on the clinical data of 31 patients with T2 stage MIBC≥3 cm in diameter who received neoadjuvant radiotherapy combined with cTURBT and adjuvant chemotherapy in Tianjin Union Medical Center from January 2018 to Decem-ber 2022.During the follow-up period,the patients'recurrence,metastasis,survival,and death were recorded.Results All 31 patients received neoadjuvant radiotherapy with a total dose of 48(44,50)Gy,Three patients(9.7%)achieved complete response,and 19 patients(61.3%)a-chieved partial response.The objective response ratewas 71.0%,and the disease control rate was 96.8%.All patients underwent cTURBT with surgery time of 37(31,42)minutes and blood loss was 20(10,30)ml.The postoperative hospitalization time was 4(4,5)days.There were no cases of obturator nerve injury,bladder perforation,ureteral opening injury,severe bleeding,or TUR syndrome during the operation.Patients were followed up for 12 to 36 months,and 9 patients(29.0%)relapsed with a median recurrence time of 18(10,23.5)months.Six patients had intra-vesical recurrence.Five of them underwent cTURBT in combination with bladder instillation thera-py,and 1 case underwent salvage radical cystectomy(RC).Two patients had both intravesical recurrence and lymph node me-tastasis.One of them received cTURBT combined with immunotherapy,and the other case received salvage RC.Only one pa-tient had multiple systemic metastases,then received palliative treatment.Conclusions The combination of neoadjuvant ra-diotherapy,cTURBT and adjuvant chemotherapy for the treatment of patients with T2 stage MIBC≥3 cm in diameter,has a high success rate in bladder preservation,and could be used as a new bladder-preserving treatment for patients who cannot or do not want to undergo RC.
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