Impact of surgical resection of bladder cancer metastases refractory to systemic therapy on performance score: a phase II trial

Otto, T.; Krege, Susanne; Suhr, J.; Rübben, H.

doi:10.1016/s0090-4295(00)00867-0

Cited by 77 publications

(45 citation statements)

References 19 publications

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“…The median OS was 42 months for patients who underwent postchemotherapy surgery, which was significantly longer than that for patients without surgery (10 months). (26) In contrast, Otto et al (27) reported that surgical resection had no impact on survival but only on the quality of life of patients with symptomatic disease. This study showed that patients with a small number of metastatic sites who underwent salvage resection had more favorable survival.…”

Section: Discussionmentioning

confidence: 97%

Paclitaxel, ifosfamide, and nedaplatin as second‐line treatment for patients with metastatic urothelial carcinoma: A phase II study of the SUOC group

et al. 2011

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There is no standard second-line chemotherapy treatment for recurrent or metastatic urothelial cancer (MUC). The purpose of this phase II study was to evaluate the efficacy and toxicity of the three-drug combination of paclitaxel, ifosfamide, and nedaplatin (TIN). Patients with MUC were eligible after treatment failure with methotrexate, vinblastine, doxorubicin, and cisplatin, or gemcitabine and cisplatin. Doses for TIN therapy were paclitaxel 175 mg ⁄ m 2 on day 1, ifosfamide 1500 mg ⁄ m 2 on days 1-3, and nedaplatin 70 mg ⁄ m 2 on day 1, every 4 weeks. Tumor response, the primary efficacy parameter, was assessed according to unidimensional measurements (Response Evaluation Criteria in Solid Tumors criteria, version 1.0). Secondary efficacy parameters were overall survival (OS) and progression-free survival (PFS). Toxicity was assessed according to the National Cancer Institute Common Toxicity Criteria, version 3.0. A total of 45 patients (13 females and 32 males) with MUC were evaluable for response and toxicity. The overall response rate was 40.0%. Median PFS time was 4.0 months (95% confidence interval [CI], 4.6-11.6). Median OS time was 8.9 months (95% CI, 10.5-18.9). Grade 3 or 4 hematologic adverse events were neutropenia (95.6%), anemia (15.6%), and thrombocytopenia (17.8%). The most common grade 3 or 4 non-hematologic adverse events were anorexia (4.4%) and elevated aspartate transaminase ⁄ alanine transaminase (2.2%). No toxic death was observed. The main limitation of this study is that only 10 patients (22.2%) who were previously treated with gemcitabine and cisplatin were included. In conclusion, TIN as second-line treatment for MUC is an active regimen with a manageable toxicity profile. (Cancer Sci 2011; 102: 1171-1175 U rothelial carcinoma of the bladder is the fourth most common cancer in men.(1) Systemic chemotherapy has been the mainstay of management for metastatic urothelial cancer (MUC).(2) Cisplatin-based combinations have evolved as the standard for first-line systemic therapy for MUC. The methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) regimen was reported to show an impressive complete remission rate of approximately 40-50% with substantial toxicity and a toxic death rate of 3-4% in MUC. (3,4) The gemcitabine and cisplatin (GC) regimen provides almost the same response rate as MVAC with less toxicity.(5) Neither of the two combinations proved superior over the other with prolongation of survival up to 14.8 and 13.8 months for MVAC and GC, respectively.(6) With cisplatin-containing combination chemotherapy, patients with lymph node metastases only, good performance status, and adequate renal function may achieve excellent response rates, including a high degree of complete responses, with up to 20% of patients achieving long-term disease-free survival.However, no standard therapy has been established for patients pretreated for MUC.(7) Recently, new combination regimens, including paclitaxel and gemcitabine, (8)(9)(10) and paclitaxel and carboplatin, (11) indicated the effi...

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Section: Discussionmentioning

confidence: 97%

Paclitaxel, ifosfamide, and nedaplatin as second‐line treatment for patients with metastatic urothelial carcinoma: A phase II study of the SUOC group

et al. 2011

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“…The significance of radical cystectomy in the treatment of muscle-infiltrating bladder carcinomas is indisputable. The development of distant metastases after the failure of local treatment almost always has fatal consequences, which limits the possibility of carrying out systemic polychemotherapy and, if necessary, metastases surgery [15,16].…”

Section: Discussionmentioning

confidence: 99%

Survival Rates after Radical Cystectomy according to Tumor Stage of Bladder Carcinoma at First Presentation

et al. 2004

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Introduction: The aim of this study was to establish to what extent the survival rates of muscle-invasive bladder carcinoma are influenced by the tumor stage at initial presentation. Patients and Methods: This study examined the clinical course of 230 patients who underwent radical cystectomy for bladder carcinoma from 1992 to 2002. The patients were divided into three groups according to the histological results of the initial and final transurethral tumor resection (TURB). In group 1 (n = 41) radical cystectomy was carried out for a superficial bladder carcinoma which had a high likelihood of progressing. Group 2 (n = 57) consisted of patients who displayed a superficial tumor stage when they first presented and developed progressive muscle-invasive bladder carcinoma under conservative treatment. Group 3 (n = 132) was made up of patients who were already at the muscle-invasive tumor stage in the course of primary TURB. The histopathological characteristics of all transurethral tumor resections and radical cystectomy were recorded. Progression-free survival and overall survival in the three groups were then compared. Results: The average patient age when cystectomy was carried out was 63.9 (35–80) years and the average follow-up period was 38 months. An average of 2.3 (1–16) transurethral tumor resections were carried out before radical cystectomy (median = 1). Progression-free survival and overall survival of all 230 patients was 54 and 50%, respectively, after 5 years. The best result was a 74% progression-free 5-year survival rate with organ-confined lymph node-negative tumors (n = 106) which was statistically significant (p = 0.0004) compared to the progression-free 5-year survival rate of 50% for non-organ-confined, lymph node-negative tumors (n = 64). Lymph node-positive patients achieved a progression-free survival rate of 21% after 5 years regardless of the tumor infiltration. Patients in group 1 achieved a progression-free 5-year survival rate of 77% and an overall survival rate of 63% after 5 years. In group 2 patients achieved a progression-free survival rate of 51% after 5 years and an overall survival rate of 50%. In the case of primary muscle invasion (group 3), progression-free survival and overall survival were 49 and 46%, respectively, after 5 years. There was no significant difference between groups 2 and 3 with regard to their progression-free or overall survival rates (p > 0.35). However, both groups displayed a significantly poorer progression-free and overall survival rate compared with group 1 (p < 0.01). Conclusion: Our results show that superficial bladder carcinoma with tumor progress to muscle invasion does not have a better prognosis after radical cystectomy than initial muscle-invasive bladder carcinoma. Survival rates in this group can only be improved by singling out patients on the basis of risk factors at an earlier stage and carrying out a cystectomy.

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“…Salvage surgery should be curative. With palliative intent, Otto et al reported on 70 patients undergoing resection of metastatic lesions after proving refractory to M-VAC chemotherapy [19]. While symptomatic patients experienced at least some relief, asymptomatic patients showed no beneficial palliative effects.…”

Section: Discussionmentioning

confidence: 99%

488 Could a Salvage Surgery After Chemotherapy Have Clinical Impact on Cancer Survival in Patients With Metastatic Urothelial Carcinoma?

Sakaguchi¹,

Bekku²,

Kobayashi³

et al. 2011

Journal of Urology

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Impact of surgical resection of bladder cancer metastases refractory to systemic therapy on performance score: a phase II trial

Cited by 77 publications

References 19 publications

Paclitaxel, ifosfamide, and nedaplatin as second‐line treatment for patients with metastatic urothelial carcinoma: A phase II study of the SUOC group

Paclitaxel, ifosfamide, and nedaplatin as second‐line treatment for patients with metastatic urothelial carcinoma: A phase II study of the SUOC group

Survival Rates after Radical Cystectomy according to Tumor Stage of Bladder Carcinoma at First Presentation

488 Could a Salvage Surgery After Chemotherapy Have Clinical Impact on Cancer Survival in Patients With Metastatic Urothelial Carcinoma?

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