Our Institutional Consensus on Tmt in MIBC: Implementation and Short-Term Experience

Background Radical cystectomy (RC) remains the gold standard for muscle-invasive bladder cancer (MIBC) but carries significant morbidity and loss of bladder function. Trimodality therapy (TMT), maximal transurethral resection of bladder tumor (TURBT) followed by chemoradiation, offers a bladder-preserving alternative with comparable outcomes in selected patients. While widely adopted in high-volume centers, data from resource-limited settings such as Lebanon are lacking. Methods We conducted a retrospective pilot study at Hôtel-Dieu de France University Hospital, Beirut, to evaluate the feasibility and outcomes of TMT since its implementation as part of our institutional consensus in October 2023. Eligible patients had cT2N0M0 urothelial carcinoma and preserved bladder function. All cases were reviewed in a multidisciplinary tumor board (MTB) to confirm eligibility. The protocol included neoadjuvant chemotherapy, repeat cystoscopy or imaging for restaging, and curative radiotherapy with concurrent weekly cisplatin. Patient characteristics, treatment delivery, MTB (multidisciplinary tumor boards) decisions, surveillance, and early outcomes were analyzed. Results Since September 2023, 28 MIBC were identified, twelve patients (median age 72; 5 women, 7 men) received the TMT and 16 patients underwent cystectomy. Presenting symptoms included hematuria (42%) and dysuria (33%). Six patients had prior intravesical BCG. Radiotherapy was completed in 30–33 fractions in all cases. Only 25% adhered to the recommended cystoscopy surveillance. After a median 12-month follow-up, bladder preservation was achieved in most, with 2 local recurrences (16.7%), both in prior BCG recipients. One patient developed pancreatic cancer. All management decisions, including recurrence, were guided by MTB consensus. Conclusions TMT implementation for MIBC, according to our institutional consensus, is feasible in Lebanon, achieving promising short-term bladder preservation with acceptable recurrence. MTB review and institutional consensus implementation were essential for patient selection and adequate management. Larger studies with extended follow-up are needed to refine protocols and validate TMT in low- and middle-income settings.