Integrated Therapy for Locally Advanced Bladder Cancer: Final Report of a Randomized Trial of Cystectomy Plus Adjuvant M-VAC Versus Cystectomy With Both Preoperative and Postoperative M-VAC

Millikan, Randall E.; Dinney, Colin P.N.; Swanson, David A.; Sweeney, Paul; Ro, Jae Y.; Smith, Terry L.; Williams, Dallas; Logothetis, Christopher J.

doi:10.1200/jco.2001.19.20.4005

Cited by 285 publications

(189 citation statements)

References 18 publications

Supporting

Mentioning

170

Contrasting

Unclassified

Order By: Relevance

“…28 However, local expertise, experience with this approach and available diagnostic imaging and resources should be considered. It should be noted that less than a third of patients who were upstaged received AC -this is in line with data indicating that NC is more often successfully administered than AC (87%-97% vs. 50%-77%), 4,29 perhaps because of postoperative complications, poor performance status and renal insufficiency. 18,22,29,30 As those receiving AC had better disease-specific survival than those who did not, the inability to administer chemotherapy adjuvantly is a significant concern.…”

Section: Discussionsupporting

confidence: 58%

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Hsu

Black

et al. 2014

CUAJ

View full text Add to dashboard Cite

Introduction: Uptake of neoadjuvant chemotherapy (NC) for muscle invasive bladder cancer (MIBC) has been low despite evidence of a survival benefit. The primary aim of this study was to better understand why the rates are low and determine what factors specifically influence the decision to recommend NC for MIBC. Methods: A 31-question survey was emailed between 2009 and 2011 to medical oncologists belonging to the Canadian Association of Genitourinary Medical Oncologists (CAGMO); and to urologists belonging to the Canadian Urologic Oncology Group (CUOG). We gathered data on practice characteristics, referrals for NC, factors influencing NC use, and chemotherapy regimens offered. Responses were summarized using descriptive statistics. Results: In total, 26/30 (87%) medical oncologists and 25/84 (30%) urologists, who were primarily academic, completed the survey. Most clinicians (medical oncologists 96%, urologists 88%) recommended NC for MIBC, because they considered it to be the standard of care, but most medical oncologists saw ≤6 referrals annually. Performance status, presence of comorbidities and renal function were key considerations in offering NC. NC was not offered if performance status ≥2 (medical oncologists 38%, urologists 44%), age >80 (medical oncologists 46%, urologists 39%), or glomerular filtration rate ≤40 mL/min (medical oncologists 81%, urologists 50%). Conclusions: Most academic clinicians in Canada believe that cisplatin-based combination NC is the standard of care for MIBC and recommend it for patients with adequate performance status and renal function. Using a multidisciplinary approach to treat this disease may be one strategy to increase referral rates for NC and uptake of NC.

show abstract

Section: Discussionsupporting

confidence: 58%

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Hsu

Black

et al. 2014

CUAJ

View full text Add to dashboard Cite

show abstract

“…It is also our practice to perform a cystoscopy, exam under anesthesia (EUA), and complete resection of all visible tumor prior to making a decision regarding upfront cystectomy or preoperative chemotherapy. At our institution most patients are considered for preoperative chemotherapy if they have "high-risk" disease, which we define as the presence of threedimensional palpable mass (cT3b) on bimanual EUA, invasion of adjacent organs (cT4a), cT2 lesion with lymphovascular invasion (LVI) on transurethral biopsy specimen, or clinically evident pelvic node metastasis on abdominal imaging [2]. Of all patients, 290 (26%) received preoperative chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

“…In approximately 10% of patients (range: 6-41%, depending on risk factors before cystectomy), no tumor is found in the specimen (pT0N0M0, "P0") at the time of radical cystectomy and PLND [1][2][3][4]. This P0 status can be due to a complete transurethral resection of the bladder tumor (TURBT) prior to cystectomy or a result of "downstaging" in patients who received preoperative chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

P0 Stage at Radical Cystectomy for Bladder Cancer is Associated with Improved Outcome Independent of Traditional Clinical Risk Factors

et al. 2007

View full text Add to dashboard Cite

Objectives-Final pathologic specimen free of detectable disease (P0) is not uncommon in patients undergoing cystectomy for bladder cancer, especially in the era of neoadjuvant chemotherapy. To improve our understanding of its significance in a contemporary series, we performed an outcomes analysis of this cohort of patients.Methods-Over the last 15 yr, 1104 patients with bladder cancer underwent radical cystectomy at our institution. Of these, 120 (11%) were pT0N0M0 (P0) in the surgical specimen and form the basis of this report. Survival data were estimated by method of Kaplan and Meier, with Cox proportional hazards regression model used to evaluate associations between survival and variables studied.Results-Clinical stages were cT1, 21 patients; cT2, 65; cT3b, 20; cT4a, 11; and cT4b, 3. The 5-yr estimates of overall (OS), disease-specific (DSS), and recurrence-free survival (RFS) rates were 84%, 88%, and 84%, respectively. With mean follow-up of 43 mo, 11 patients developed recurrences, 9 of whom died of disease. Median time to recurrence was 7.7 mo (range: 2.2-45 mo). On multivariate analysis, presence of lymphovascular invasion and concomitant carcinoma in situ on the transurethral resection of the bladder tumor specimen were the only significant prognostic factors associated with shorter OS (p = 0.04) and RFS (p = 0.049), respectively. Notably, patients who received preoperative chemotherapy (n = 77) had 5-yr survival rates similar to those of patients who did not. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-Although patients who are P0 at cystectomy have a good prognosis, not all can be cured. The favorable prognosis conferred by a P0 state appears to be independent of whether this is achieved by neoadjuvant chemotherapy or by thorough transurethral resection before cystectomy. NIH Public Access

show abstract

“…12,13 The pT0 rate increased from 15% to 38% in the Intergroup trial and from 12.3% to 32.5% in the MRC/EORTC trial. Patients with pT0 disease have an excellent survival rate, and those with positive surgical margins invariably succumb to the disease.…”

Section: The Case For Neoadjuvant Chemotherapymentioning

confidence: 99%

“…Further risk stratification may include patients with cT2 tumours associated with hydronephrosis or lymphovascular invasion, since patients with these risk factors fare as poorly as patients with cT3 tumours. 13,16 The argument against use in patients with cT2 tumours is that these patients have an excellent likelihood of cure with cystectomy alone and the incremental benefit of neoadjuvant chemotherapy may not be worth the risk of toxicity. The absolute survival benefit of neoadjuvant chemotherapy appears to be the same across all stages but the relative improvement is greater for higher stages.…”

Section: The Case For Neoadjuvant Chemotherapymentioning

confidence: 99%

Perioperative chemotherapy for muscle-invasive bladder cancer

Black

2013

CUAJ

View full text Add to dashboard Cite

Considerable debate exists concerning the combined use of systemic chemotherapy and radical surgery for muscle-invasive bladder cancer. While there is evidence for a survival benefit after neoadjuvant chemotherapy, the benefit is modest and the potential toxicity and delay of time to surgery prior to cystectomy appears to be deterring many surgeons from its administration. The evidence for adjuvant chemotherapy, on the other hand, is less compelling and substantial. Furthermore, the role of adjuvant compared to salvage chemotherapy requires further investigation. Similarly, research continues on identifying molecular and clinical markers to best stratify patients for optimal perioperative therapy. In this article, the evidence for radical cystectomy and chemotherapy, given either in a neoadjuvant or adjuvant setting, will be reviewed. Can Urol Assoc J 2009;3(Suppl4):S223-7T ransitional cell carcinoma of the bladder is chemosensitive, 1-3 but its use in the neoadjuvant and adjuvant settings combined with radical cystectomy remains controversial. Despite aggressive surgical management, up to 50% of patients with muscle-invasive bladder cancer will develop tumour recurrence, suggesting that a significant proportion of these patients have micro-metastases at the time of surgery. 4 Early application of multimodal therapy in bladder cancer is therefore an attractive paradigm.

show abstract

Integrated Therapy for Locally Advanced Bladder Cancer: Final Report of a Randomized Trial of Cystectomy Plus Adjuvant M-VAC Versus Cystectomy With Both Preoperative and Postoperative M-VAC

Cited by 285 publications

References 18 publications

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

Treatment of muscle-invasive bladder cancer in Canada: A survey of genitourinary medical oncologists and urologists

P0 Stage at Radical Cystectomy for Bladder Cancer is Associated with Improved Outcome Independent of Traditional Clinical Risk Factors

Perioperative chemotherapy for muscle-invasive bladder cancer

Contact Info

Product

Resources

About