Response and progression-free survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation

Mayans, A. Rincón; Costa, D. Rosell; Bergera, J.J. Zudaire; Zuazu, J. Rioja; Abad, J. Barba; Eizaguirre, E. Tolosa; Vargas, L. Romero; Piédrola, I. Pascual

doi:10.1016/s2173-5786(10)70193-1

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…One randomized trial, 7 retrospective cohort studies, and 1 nonrandomized clinical trial compared bladder‐sparing therapy versus radical cystectomy alone or in combination with chemotherapy (see Supporting Information Table 1) . Sample sizes ranged from 145 to 2455 patients.…”

Section: Resultsmentioning

confidence: 99%

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Treatment of muscle‐invasive bladder cancer: A systematic review

Chou

Selph

Buckley

et al. 2016

Cancer

107

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There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens. Cancer 2016;122:842-51. V C 2016 American Cancer Society.KEYWORDS: adjuvant chemotherapy, bladder cancer, bladder-sparing therapy, lymph node dissection, neoadjuvant chemotherapy, radical cystectomy. INTRODUCTIONBladder cancer reportedly affected nearly 75,000 Americans in 2014. 1 Bladder cancer that invades muscle (classified as T2 using the American Joint Committee on Cancer TNM staging system) can rapidly progress and metastasize, and is associated with a poor prognosis. 2 Approximately 30% of newly diagnosed bladder cancers present as muscle-invasive. 3 For clinically localized (T2-T4a) muscle-invasive bladder cancer in patients with adequate renal function, standard treatment is neoadjuvant systemic chemotherapy with a platinum-based regimen followed by radical cystectomy and urinary diversion. 4 Regional lymph node dissection is recommended in conjunction with cystectomy. Because cystectomy necessitates reconstruction with a urinary diversion, bladder-sparing alternatives that include external beam radiotherapy with or without chemotherapy, partial cystectomy, and maximal transurethral resection of bladder tumor (TURBT) 5 have been evaluated as alternative options. Other therapeutic considerations include the role of adjuvant (administered after surgery) chemotherapy (AC), the optimal extent of lymph node dissection, and which specific chemotherapy regimen to select.Given the uncertainty regarding the comparative effectiveness of therapies for clinically localized, muscle-invasive bladder cancer, we c...

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Section: Resultsmentioning

confidence: 99%

“…Two nonrandomized studies were rated medium risk of bias and 6 studies were rated high risk of bias. The studies rated high risk of bias did not attempt to adjust for potential confounders, did not clearly report adjusted results, or included comparison groups that were not entirely concurrent …”

Section: Resultsmentioning

confidence: 99%

Treatment of muscle‐invasive bladder cancer: A systematic review

Chou

Selph

Buckley

et al. 2016

Cancer

107

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“…RT doses of 64 Gy and 60.8 Gy were compared in a study by Horwich et al (24), and all of the comparative study parameters of local control, toxicity and survival results were found to be comparable and not statistically significant for the 2 different total RT doses (24). Doses exceeding 60 Gy and ureteral obstruction were considered survival-free prognostic indicators in a study by Rincón et al (25). Although doses at a range of 60 to 66 Gy are widely used worldwide for bladder preservation, a 70–70.4 Gy total bladder boost dose was given after completion of 50–50.4 Gy whole pelvis RT in a study from Austria (26).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Trimodality Approach in the Management of T2N0M0 Bladder Cancer

Uysal

Beyzadeoğlu

Demiral

et al. 2015

Tumori

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A feasibility study of transurethral resection followed by radiotherapy combined with concurrent twice-weekly gemcitabine in the treatment of invasive bladder carcinoma

Osama

Shalaby

Aboziada

2013

JST

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Introduction and Aim: Radical cystectomy is the traditional treatment of cancer bladder; however, bladder preservation in selective patients is beneficial. To evaluate the efficacy of transurethral resection plus chemo-radiation in achieving bladder preservation, using conformal radiotherapy and twice weekly Gemcitabine. Patients and Methods:Thirty seven patients with good performance status, and maximum trans-urethral resection received 46GY /23 fractions with twice weekly Gemcitabine 30mg/m 2 . Evaluation was done after 2 weeks by cystoscopy and biopsy from the tumor bed. Patients who had complete response (CR) subjected for phase II 20 GY/10 fractions /2 weeks with twice weekly Gemcitabine 30 mg/m 2 . However, patients who had incomplete response subjected for radical cystectomy.Results: Thirty two (86.4%) patients had CR. The treatment schedule was tolerable and was associated with moderate toxicity that was easily treated. Six patients developed G3 toxicity that required treatment interruption until improvement. After 2 years of follow up, 29 patients achieved good local control with 2 years local recurrence free survival was 79%. The 2 years overall survival and bladder intact survival was 70% and 69% respectively. Conclusions:Tri-modality bladder-sparing approach consists of transurethral resection, chemotherapy twice weekly Gemcitabine and radiotherapy is well tolerated, with high rate of bladder preservation. This approach may be considered as a reasonable alternative to cystectomy in the proper selected patients.

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Response and progression-free survival in T2 to T4 bladder tumors treated with trimodality therapy with bladder preservation

Cited by 3 publications

References 10 publications

Treatment of muscle‐invasive bladder cancer: A systematic review

Treatment of muscle‐invasive bladder cancer: A systematic review

Outcomes of Trimodality Approach in the Management of T2N0M0 Bladder Cancer

A feasibility study of transurethral resection followed by radiotherapy combined with concurrent twice-weekly gemcitabine in the treatment of invasive bladder carcinoma

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