Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer

Cobo, Manuel; Delgado, R. Vivancos; Gil, Silvia; Herruzo, Ismael; Baena, V.; Carabante, Francisco; Moreno-Moreno, Paloma; Ruiz, Jessica; Bretón, J.J.; Rosal, Joebert; Fuentes, C.; García, E. Lledó; Villar, Esther; Contreras, Jorge; Alés, Inmaculada; Benavides, Manuel

doi:10.1007/s12094-006-0154-1

Cited by 16 publications

(9 citation statements)

References 29 publications

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“…Despite the discouraging results of the RTOG Phase III trial regarding the role of neoadjuvant CT,12 several investigators from different institutions have reported on protocols that incorporated neoadjuvant CT into a multimodality treatment 19–21. Danesi et al19 evaluated a schedule of concurrent cisplatin and 5‐fluorouracil delivered by protracted intravenous infusion during hyperfractionated RT.…”

Section: Discussionmentioning

confidence: 99%

“…This finding accords with our findings that T classification, together with resection status after TUR, had the strongest impact on overall survival. More recently, Cobo et al21 reported on 29 patients who underwent TUR and received neoadjuvant CT and RCT followed by consolidation RT when a CR was achieved. Again, those investigators reported that early‐stage disease and initial complete resection were predictive of the best outcome.…”

Section: Discussionmentioning

confidence: 99%

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Bladder‐sparing, combined‐modality approach for muscle‐invasive bladder cancer

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Autorino

Damiano

et al. 2007

Cancer

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BACKGROUND. The authors evaluated their long‐term experience with combined‐modality, conservative treatment in patients with muscle‐invasive bladder cancer. METHODS. In total, 121 patients with T2, T3, or T4 bladder cancer (mean age, 63 years; ratio of men to women, 3:1) underwent induction by transurethral resection (TUR) of the tumor and received 2 cycles of neoadjuvant chemotherapy followed by radiotherapy (RT) (n = 43 patients) or radiochemotherapy (RCT) (n = 78 patients). Six weeks after RT or RCT, responses were evaluated by restaging TUR. Patients who achieved a complete response (CR) were observed at regular intervals. In patients who had persistent or recurrent invasive tumor, further treatment was recommended. RESULTS. Local response evaluation by restaging TUR was possible in 119 patients, and 102 of those patients (85.7%) achieved a CR. After a median follow‐up of 66 months (range, 6–182 months), no local or distant disease recurrences were observed in 67 of 102 complete responders (65.7%), 17 of 102 complete responders (16.7%) experienced superficial local disease recurrence, and 18 of 102 complete responders (17.6%) had a muscle‐invasive relapse. The 5‐year tumor‐specific, overall, and bladder‐intact survival rates were 73.5%, 67.7%, and 51.2%, respectively. Treatment modality, tumor classification, and resection status after initial TUR had an impact on survival rates (P = .04, P = .02, and P = .02, respectively). CONCLUSIONS. The current results indicated that conservative combined treatment is a reasonable alternative to radical cystectomy in selected patients with muscle‐invasive bladder cancer. Cancer 2008. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bladder‐sparing, combined‐modality approach for muscle‐invasive bladder cancer

Perdonà

Autorino

Damiano

et al. 2007

Cancer

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“…Salvage cystectomy ratewas 29%at 5 year [15]. In multiple series, the 5 &10-year OS for RCwas 45%-60% and 37% -45%, respectively [2][3][4][5][6][7] while, the 5-year OS for BPT utilizing trimodal therapy was 36-74% [21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 92%

Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience

Awad Abd Allah

2019

CRJ

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Background & objective: Bladder preservation therapy (BPT) using a trimodality approach represents an alternative option to cystectomy inmuscle-invasive bladder cancer (MIBC) patients, also a treatment option in non-cystectomy candidates. The objective of this study was to evaluate BPT using a trimodality approach composed of maximum TURBT, neoadjuvant chemotherapy, followed by chemoradiotherapy, regarding the overall survival (OS), progression free survival (PFS), locoregional progression free survival (LPFS) and treatment toxicity. Patients & methods: This prospective study involved 47 patients with pathologically proven MIBC (T2-T4a N0M0). The study involved muscle invasive bladder cancer patients who refused or were not cystectomycandidates. Patients enrolled received neoadjuvant 3cycles of Gemcitabine/Cisplatin, each cycle was every 21 days. Gemcitabine at 1000mg/m 2 on days 1&8 and cisplatin at 70mg/m 2 on day1, followed by Concurrent chemordiotherapy with cisplatin weekly (40mg/m 2 ). Radiation therapy included the whole bladder by 3D conformal planning to a dose of 64Gy/32Fxs. Results: Of the 47 patients, 25 (53.2%) patients expressed complete response (CR), while 22(46.8%) patients had incomplete response. The 4-year OS, PFS, and LPFS rates were 48%, 38%, and 42%, respectively. Acute genitourinary (GU) toxicity of Grade 1 and 2 occurs in 54% and 24%of patients, respectively, while acute gastrointestinal (GI) toxicity (colic &diarrhea) of Grade 1 and 2 occurs in 27.7% and 10.6 %of patients, respectively. Conclusion: For MIBC patients who are non-cystectomy candidates, or who are motivated to maintain their bladders, trimodality bladder preservation therapy (BPT) can be considered as an effective alternative to radical cystectomy.

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“…In contemporary series, 5-and 10-year overall survival for radical cystectomy is reported between 45% to 60% and 37% to 45%, respectively [2][3][4][5][6][7]. The 5-year overall survival for bladder preservation using trimodality therapy falls within a similar range at 36-74% [25,[27][28][29]33,36,37,[46][47][48][49][50]. Currently, bladder preservation appears to be a viable alternative to radical cystectomy in patients who may be poor surgical candidates or in those who may opt not to undergo radical cystectomy.…”

Section: Discussionmentioning

confidence: 98%

Bladder preservation in the treatment of muscle-invasive bladder cancer

Prado

Gollapudi

King

et al. 2014

Bladder

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Organ preserving strategies are being increasingly utilized in the treatment of solid malignancies with the intent of reducing surgical morbidity and maintaining quality of life. Organ preservation becomes a viable approach only when cancer outcomes are not compromised when compared to radical resection. We reviewed the current literature on bladder preservation for muscle-invasive bladder cancer, focusing on trimodality therapy consisting of complete transurethral resection, radiation therapy, and chemotherapy. Acknowledging the absence of randomized clinical trials, differences in patient selection, and variation in study protocols, trimodality therapy may yield similar 5-and 10-year overall survival rates compared to radical cystectomy alone. This includes the approximately 30% of patients who enter a bladder preservation protocol and undergo salvage radical cystectomy for failure of local control. Currently, bladder preservation appears to be an alternative to radical cystectomy in select patients who have appropriate rigorous surveillance.

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Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer

Abstract: Combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients with TCC. Patients with T2 stage and complete histologic resection in initial TURB had the best outcome.

Cited by 16 publications

References 29 publications

Bladder‐sparing, combined‐modality approach for muscle‐invasive bladder cancer

Bladder‐sparing, combined‐modality approach for muscle‐invasive bladder cancer

Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience

Bladder preservation in the treatment of muscle-invasive bladder cancer

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