Multimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Tumors

Fernando, Shaneli; Sandler, Howard M.

doi:10.1053/j.seminoncol.2006.12.009

Cited by 13 publications

(10 citation statements)

References 40 publications

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“…This approach is attractive for elderly patients with bladder cancer whose comorbidities may place them at greater risk for short-and long-term complications related to surgery; however, the majority of bladder preservation protocols have included only patients who are candidates for radical cystectomy. No randomized trials have compared bladder sparing with radical cystectomy, although approximately 50% long-term disease-free survival is reported for the bladder-sparing approach, which is comparable to the results of modern cystectomy series [31]. An extensive TURBT is required for successful bladder-sparing therapy, and in one multivariable analysis was the only independent prognostic factor for long-term survival [32•].…”

mentioning

confidence: 80%

“…Cisplatin is among the most active agents in bladder cancer. As a result, the majority of chemoradiation trials in bladder cancer have utilized concurrent cisplatin with complete response rates in the 59-75% range, and 5-year survival of approximately 50% [31]. • Cisplatin is often problematic in older patients with coexisting medical problems, and alternative options have been investigated.…”

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confidence: 99%

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Bladder Cancer

Gallagher

Milowsky

2009

Curr. Treat. Options in Oncol.

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Bladder cancer is a complex disease of older patients with coexisting medical problems requiring multimodal therapy. For patients with localized bladder cancer, standard management for superficial disease includes transurethral resection with or without intravesical therapy, while muscle-invasive cancer is managed with neoadjuvant cisplatin- based chemotherapy followed by radical cystectomy. Comorbid conditions prevent many older patients from receiving cisplatin-based chemotherapy and/or undergoing surgery. Tri-modality bladder preservation approaches including a complete transurethral resection of the bladder tumor (TURBT) followed by combined chemotherapy and radiation have generally included only those patients who are candidates for a salvage cystectomy. Future research must specifically focus on older adults with bladder cancer including non-cisplatin-based neoadjuvant regimens; bladder preservation strategies using alternative non-cisplatin chemotherapy in noncystectomy candidates; clinical trials evaluating novel targeted agents in older adults; and geriatric assessment tools to assist in decision making.

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confidence: 80%

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confidence: 99%

Bladder Cancer

Gallagher

Milowsky

2009

Curr. Treat. Options in Oncol.

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“…Candidates for bladder-sparing techniques traditionally have been patients with small tumors (<5 cm), cT2 disease, absence of extensive CIS, absence of hydronephrosis, and no evidence of pelvic lymphadenopathy, and those who undergo a complete TURBT. 17,29 These recommendations are derived from unadjusted models, wherein absence of any one of these clinical factors was associated with failure of multimodality therapy. Coen et al 30 sought to develop more sophisticated instruments to determine whether additional patients who do not meet traditional inclusion criteria should be considered for bladdersparing treatment.…”

Section: Success Of Bladder-sparing Techniquesmentioning

confidence: 99%

Predictors of Outcome in Bladder Cancer

Eifler

Barocas

Resnick³

2014

J Natl Compr Canc Netw

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Tumor stage and grade have largely been responsible for directing treatment algorithms in bladder cancer. However, the considerable heterogeneity of tumor biology in bladder cancer is incompletely characterized by stage and grade alone, and recent efforts to improve predictive models in bladder cancer may significantly improve accuracy and calibration. This article addresses how current nomograms and risk tables may be best used to individualize bladder cancer management.

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“…3 Therefore, recent strategies have combined the three modalities: transurethral resection of the bladder tumour (TURBT), chemotherapy and radiation therapy in an attempt to improve longterm survival and bladder preservation rates, 4 with salvage cystectomy being reserved for patients with incomplete response or local relapse. [7][8][9][10][11] Despite these encouraging results, the outcome of the organ-sparing approach needs to be compared with the surgical standard. 3 For all patients, overall survival (OS), cancer-specific survival and OS with bladder preservation (OSBP) rates at 5 years reached 58, 60 and 51%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Trimodality bladder-sparing approach versus radical cystectomy for invasive bladder cancer

et al. 2014

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Purpose: To compare the outcome among patients with invasive bladder cancer treated with cystectomy alone with outcome among those treated with combined-modality treatment in a randomised phase III trial.Patients and methods: Patients with histologically confirmed invasive non-metastatic bladder cancer T2-3, N0 and M0 were randomly assigned to two arms: Arm 1: of which all patients underwent radical cystectomy (RC) alone; and Arm 2, of which all patients were subjected to maximal transurethral resection of bladder tumour, followed 2 weeks later by combined chemoradiotherapy. The whole pelvis received 46 Gy in 23 fractions over 4?5 weeks. Chemotherapy was administered concomitantly with radiotherapy with: cisplatin 70 mg/m 2 q. 3 weeks and Gemcitabine 300 mg/m 2 D 1, 8 and 15 q. 3 weeks for two cycles. Patients who had complete response were shifted to phase II treatment: 20 Gy/10 fractions/2 weeks to the bladder. Patients with residual tumour underwent RC.Results: Of the 80 patients assigned Arm 2, a visibly completed transurethral resection of the bladder tumour was possible in 48 patients (60%). Phase I of combined chemoradiotherapy (CCRT) was accomplished in 74 patients. Post-induction urologic evaluation revealed no evidence of disease in 62 patients (83?8%) and residual disease in 12 patients (16?2%). Phase II of CCRT was completed in 58 of the 62 patients. The median follow-up for all patients is 27 months (range: 4-49). The 3-year overall survival (OS) for the combined-modality group and for the surgery group were 61 and 63%, respectively (p 5 0?425), whereas the disease-specific survival (DSS) for each group was 69 and 73%, respectively (p 5 0?714). The 3-year OS with bladder preservation for Arm 2 patients was 50%. Multivariate analysis for the whole series showed that tumour stage and performance status (PS) were the only factors independently associated with DSS, although PS was the only factor independently associated with OS. In addition, residual disease after transurethral resection of the bladder tumour in Arm 2 patients was independently associated with both DSS and OS. Acute toxicity was moderate and most of the late toxicities were grade 2 with no grade 4 toxicity and no treatment-related deaths, none required cystectomy for bladder contraction. 428Conclusion: This study demonstrates that trimodality bladder-preserving approach represents a valid alternative for suitable patients. The OS and DSS rates of patients treated with trimodality bladder-preserving protocol are comparable to the results reported on patients treated with immediate radical cystectomy.

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Multimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Tumors

Cited by 13 publications

References 40 publications

Bladder Cancer

Bladder Cancer

Predictors of Outcome in Bladder Cancer

Trimodality bladder-sparing approach versus radical cystectomy for invasive bladder cancer

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