Role of surgical consolidation in metastatic urothelial carcinoma

Abstract

Purpose of reviewSince the development of systemic combination chemotherapy, postchemotherapy extirpation has been performed in selected patients mainly with locally advanced and/or initially unresectable bladder cancer, and, in very selected patients, surgical consolidation for visceral metastases has also been performed. The purpose of this article was to review and summarize the current evidence for the role of surgical consolidation in metastatic urothelial carcinoma.Recent findingsThe role of metastasectomy has not yet been examined in a randomized setting. In terms of locally advanced and/or node-positive bladder cancer, studies further support the benefit of surgical consolidation, especially after a favorable response to systemic chemotherapy. Regarding metastasectomy for visceral metastasis, recent evidence suggested that lung metastases (ideally small solitary lesions) are a good indication.SummaryPatients with a good response to chemotherapy, limited nodal/pulmonary disease, and a favorable performance status are good candidates for surgical consolidation. Careful patient selection is mandatory.

The Impact of Cisplatin- or Non-Cisplatin-Containing Chemotherapy on Long-Term and Conditional Survival of Patients with Advanced Urinary Tract Cancer

“…The role of consolidation surgery in aUTC is not as well defined as that in other solid tumors [26]. In concert with previous findings [26], we found that long-term survival in patients undergoing surgery almost exclusively occurred after a favorable response to chemotherapy: Only 1 of 11 patients (9%) survived 3 years when surgery was performed after progression on chemotherapy, as opposed to 8 of the 21 patients Long-Term Survival in aUTC (38%) who were operated following an objective response to chemotherapy. Type of chemotherapy did not seem to affect postsurgery outcome.…”

Management of Urothelial Bladder Cancer in Clinical Practice: Real-World Answers to Difficult Questions

“…However, some patients can achieve long-term favorable outcomes with this approach. 41 In one series, median survival from time of metastasectomy was 23 months, whereas 5-year OS rate was 33%. 42 In another series, 5-year OS rate from metastasectomy was 28%.…”

“…On the basis of composite retrospective data, ideal metastasectomy candidates would demonstrate good response to NAC and show disease stability without rapid progression. 41 Fluorodeoxyglucose-positron emission tomography/computed tomography may be more useful than conventional contrast-enhanced computed tomography for assessing postchemotherapy treatment response of nonurinary tract lesions in urothelial carcinoma. 44 Other important characteristics include small disease volume, preferably at a single site, which is accessible for resection with negative margins, and an otherwise good health status.…”

Clinical Case of Multimodality Treatment of Metastatic Bladder Cancer

“…Стоит также отметить, что данные группы препаратов дороги и не всегда доступны. При этом ряд авторов сообщают о допустимости удаления отдаленных очагов в комбинации с системной терапией и возможном влиянии данной стратегии на выживаемость [12][13][14][15][16][17][18][19][20]. Представленный клинический случай показывает возможные способы контроля прогрессирующего метастатического РМП.…”