Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer

Shipley, William U.; Kaufman, Donald S.; Zehr, E; Heney, Niall M.; Lane, S.C.; Thakral, Harjot; Althausen, Alex F.; Zietman, Anthony L.

doi:10.1016/s0090-4295(02)01650-3

Cited by 288 publications

(165 citation statements)

References 31 publications

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“…Patients who are medically fit for radical cystectomy but who have hydronephrosis are poor candidates for bladder-sparing procedures. 51,52 Maximal TURBT with concurrent chemoRT should be given as primary treatment for these patients, with RT alone or TURBT alone reserved for select patients.…”

Section: Bladder Preservationmentioning

confidence: 99%

“…[51][52][53][54][55][56][57][58][59] A combined analysis of survivors from these 4 trials, with a median follow-up of 5.4 years, showed that combined-modality therapy was associated with low rates of late grade 3 toxicity (5.7% genitourinary and 1.9% gastrointestinal). 61 No late grade 4 toxicities or treatment-related deaths were recorded.…”

Section: Rt With Concurrent Chemotherapy Followingmentioning

confidence: 99%

See 1 more Smart Citation

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Spiess¹,

Agarwal²,

Bangs³

et al. 2017

J Natl Compr Canc Netw

228

173

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OverviewAn estimated 79,030 new cases of urinary bladder cancer (60,490 men and 18,540 women) will be diagnosed in the United States in 2017 and approximately 16,870 deaths (12,240 men and 4630 women) will occur. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines Disclosures for the NCCN Bladder Cancer PanelAt the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself.Individual disclosures for the NCCN Bladder Cancer Panel members can be found on page 1267 (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.)These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Bladder Preservationmentioning

confidence: 99%

Section: Rt With Concurrent Chemotherapy Followingmentioning

confidence: 99%

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Spiess¹,

Agarwal²,

Bangs³

et al. 2017

J Natl Compr Canc Netw

228

173

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“…Rödel et al (2002a) recently described a large experience with organ-sparing treatment of invasive bladder cancer, documenting long-term outcome of 415 patients treated over a 20-year time period showing promising results. Zietman et al (1993) and Shipley et al (1985Shipley et al ( , 2002 from Massachusetts General Hospital and Sauer et al (1998) from Erlangen have reported promising results with organ preservation strategies over the last decade that offered hope and an option for bladder preservation in a significant proportion of patients who currently undergo cystectomy.…”

Section: Role Of Synchronous Chemoradiotherapymentioning

confidence: 99%

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

et al. 2004

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We conducted a phase I/II study investigating synchronous chemoradiotherapy with mitomycin C and infusional 5-fluorouracil (5-FU) in muscle invasive bladder cancer. Early dose escalation results were previously published. We report the long-term toxicity and efficacy results with the optimised regimen. Patients with muscle invasive bladder cancer with glomerular filtration rate 425 ml min À1 were eligible. Mitomycin (12 mg m À2 on day 1 only) and infusional 5-FU (500 mg m À2 day À1 ) for 5 days were administered during weeks 1 and 4 of radiotherapy of 55 Gy in 20 fractions. A total of 41 patients were enrolled, median age was 68 years, 33 were male and eight female patients. Out of the 41 patients, 20 (49%) had hydronephrosis at presentation and 25 (62%) had T3b or T4 disease. Four patients experienced Grade III thrombocytopenia and three patients had Grade III neutropenia. There were no episodes of febrile neutropenia. Four patients experienced Grade III diarrhoea and 1 Grade III urgency and dysuria. Six patients did not undergo cystoscopic evaluation due to early metastatic spread although there was no clinical suggestion of bladder failure. In all, out of 35 evaluable patients, 25 (71%) had macroscopic complete response at 3-month cystoscopy, and biopsy confirmed in 24 out of 25. A total of 16 (39%) patients remain alive with a median follow-up of 50.7 (range 23.5 -68.8) months, 14 with a functioning bladder with no reported long-term treatment-related bladder or bowel toxicity. Five out of 41 patients have undergone salvage cystectomy: two for persistent CIS, two T1 and one muscle invasive recurrence. Four patients have received intravesical chemotherapy, of whom two remain alive with a functioning bladder. Overall 12-, 24-and 60-month (m) survival rates were 68, 49 and 36%. Local and distant progression free rates were 82 and 86% at 12-m and 79 and 75% at 24-m. Organ preservation using multimodality therapy is feasible and safe, even in patients with poor renal reserve, and does not compromise salvage therapies. A national phase III trial BC2001 (www.bc2001.org.uk) exploring the effects of synchronous chemoradiotherapy with this regimen is currently recruiting.

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“…In the present study, prognostic factor which affects CR after phase 1 was the presence of hydronephrosis, comparable with Rincon et al [2] . In the MGH series [17] , 27 of 190 patients had hydronephrosis initially, and their complete response rate was 37%, compared to 68% in patients without hydronephrosis (p=0.002). Other factors like early stage and maximum TURBT are significantly affecting the response [13,[16][17][18][19][20] .…”

Section: Discussionmentioning

confidence: 98%

“…In the Massachusetts General Hospital (MGH) series of 190 patients between 1986 and 1998 treated by trimodality therapy, 63% exhibited a CR [17] . In the present study, prognostic factor which affects CR after phase 1 was the presence of hydronephrosis, comparable with Rincon et al [2] .…”

Section: Discussionmentioning

confidence: 99%

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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Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer

Cited by 288 publications

References 31 publications

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive 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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