Invasive bladder cancer:A single-institution experience with bladder-sparing approach

Zapatero, A.; Vidales, C. Martín de; Marín, Alicia C; Cerezo, Laura; Arellano, R.; Rabadán, M; Pérez-Torrubia, Armando

doi:10.1002/1097-0215(20001020)90:5<287::aid-ijc6>3.0.co;2-9

Cited by 23 publications

(2 citation statements)

References 29 publications

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“…In past studies, patients frequently received chemotherapy concurrently with radiation [6,[8][9][10][11] with some studies incorporating a neoadjuvant methotrexate-cisplatin-vinblastine (MCV) chemotherapy regimen prior to radiation [12,13]. Zapatero et al [14] clinical trial was a small trial of 80 patients with muscle-invasive bladder cancer, in which 41 patients received the MCV regimen followed by 60 Gy radiation to the bladder, and 39 received concurrent cisplatin with 64.8 Gy radiation to the bladder.…”

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confidence: 99%

Comparison of sequential versus concurrent chemoradiation regimens in non-metastatic muscle-invasive bladder cancer

Vieira,

Kasper,

Wang

et al. 2023

Radiat Oncol J

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Purpose: The treatment approach for non-metastatic bladder cancer is guided by an invasion of the muscular layer of the bladder wall. Radical cystectomy is the recommended treatment for muscle-invasive disease. However, it has considerable morbidity and mortality and is not suited for many patients. Trimodality therapy consisting of chemoradiation after transurethral resection of bladder tumor offers a definitive approach with bladder-sparing potential. However, there is a lack of research defining the optimal combination of chemotherapy and radiation in this setting.Materials and Methods: We extracted patient data from the National Cancer Database to compare survival outcomes and demographic factors in 2,227 non-metastatic bladder cancer patients who were treated with chemotherapy sequential to or concurrently with radiation. Sequential treatment was defined as chemotherapy beginning >14 days before radiation, and concurrent was defined as beginning within 14 days of the first radiation.Results: The sequential treatment group patients were younger (mean age, 74 vs. 78 years; p < 0.001) with more advanced disease. We found no difference in overall survival between patients who received chemotherapy sequential to radiation and those who received concurrent chemoradiation only (p = 0.533).Conclusion: Our data are concordant with a previous prospective study, and support that chemotherapy prior to radiation does not decrease survival outcomes relative to patients receiving only concurrent chemoradiation. Given that the sequential group had an overall higher stage but no difference in survival, downstaging chemotherapy prior to radiation may be helpful in these patients. Further studies including a larger, multi-institutional clinical trial are indicated to support clinical decision-making.

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Section: Introductionmentioning

confidence: 99%

Comparison of sequential versus concurrent chemoradiation regimens in non-metastatic muscle-invasive bladder cancer

Vieira,

Kasper,

Wang

et al. 2023

Radiat Oncol J

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“…It includes transurethral resection of all visible bladder tumor and postoperative chemo-radiotherapy [9][10][11][12]. The reported success rates of this trimodality treatment is compared or even higher than that of RCE, which makes it a viable alternative [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Nevertheless, mentioned trimodality approach possesses one significant disadvantage, namely, high local recurrence rate, which is estimated in the range of 30-70% of cancer persistence during repeated TURB [7].…”

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confidence: 99%

Bladder sparing surgery in high-grade bladder cancer

2023

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Summary. The gold standard for managing muscle-invasive bladder cancer is radical cystectomy (RCE). The RCE is a treatment, which carries high burden of perioperative morbidity and mortality. As biomolecular markers make muscle-invasive high-grade bladder cancer (HGBC) an entity different from non-invasive papillary disease, we tested a hypothesis that alternative bladder preserving surgery (BPS) approaches, such as partial cystectomy and transurethral resection of the bladder would not compromise the oncological results of treating HGBC in selected patients. Aim: To study the cancer specific survival of HGBC patients depending on the mode of surgical treatment — RCE, partial en-block cystectomy, and transurethral resection of the bladder in the practice of the Departments of Urology and Oncology of Bogomolets National Medical University, and to assess the prevalence of bladder sparing surgical management of HGBC in local practice as a part of trimodal treatment approach to bladder preservation. Materials and Methods: Retrospectively we studied the medical records of 3597 urothelial bladder cancer patients, of whom 346 (10%) had high-grade disease and who underwent surgical treatment in 2004–2017. All patients were studied with contact computed tomography of the chest, abdomen, pelvis, and biopsy of the tumor. Based on the results of the diagnostic workup the choice of surgical treatment between RCE, partial cystectomy and transurethral resection was made considering the size of the tumor, location of the tumor in the bladder in relation to the bladder neck, and technical and oncological feasibility of performing the bladder sparing surgery. Kaplan — Meier survival curves were built to compare the results of survival per cancer stage and type of surgical treatment. Survival data of the patients were collected from the cancer registry maintained at the Kyiv Municipal Clinical Oncological Center. Results of data analysis were controlled for confounding parameters, such as adjuvant treatment: perioperative radiotherapy, and chemotherapy. Results: Median follow-up was 93 months (1–226 months). Males were 276 (80%). Average age at diagnosis was 62 ± 4.5 years. By the time of the study 61% of patients have died due to the progression of the disease. All patients with stage I disease (7% or 24 patients) were managed with bladder-sparing surgery. In muscle-invasive disease (309 patients), the RCE was performed in 109 (35.3%) patients, partial cystectomy was performed in 79 (25.6%) patients, and transurethral resection — in 121 (39.1%) patients. The overall 5-year survival of HGBC patients after radical surgical treatment (RCE/BPS) for stage I patients was 0%/83%, for stage II — 43%/58%, for stage III — 37%/42%, and for stage IV — 10%/40%. A total of 44 patients (12.7% of all treated, and 19.6% of treated with bladder sparing) received postoperative radiotherapy after bladder-sparing surgery. A total of 14 patients (4% of all treated) received postoperative chemotherapy. Conclusion: Bladder sparing surgery (partial en-block cystectomy, and transurethral resection of the bladder) in selected patients is not inferior to RCE in terms of cancer-specific survival when treating patients with HGBC of all stages. The bladder sparing surgery was performed in 64.7% of patients with high grade bladder cancer. Utilization of adjuvant treatment is low, 12.7% for postoperative radiotherapy, and 4% for perioperative chemotherapy

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Bladder preservation in muscle‐invasive bladder cancer by conservative surgery and radiochemotherapy

Dunst

Rödel

Zietman

et al. 2001

Seminars in Surgical Oncology

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Organ preservation has been investigated in muscle-invasive bladder cancer over the past decades as an alternative to standard radical cystectomy. The results of large prospective protocols and population-based studies suggest that an organ-preserving approach is possible without deferring the survival probability. Organ preservation requires a trimodal schedule, including transurethral surgery (transurethral resection of bladder tumor (TURBT)), radiation, and chemotherapy. A complete TURBT is the most important single prognostic factor, and should be attempted. Radiotherapy, in conjunction with concurrent platinum-based chemotherapy, can control the vast majority of urothelial bladder tumors. The histologically-proven complete remission rates of macroscopic tumors (unresectable by TURBT) lie in the range of about 70%. After radiochemotherapy, a histological response evaluation with repeated TURBT is recommended. Patients with residual tumor require salvage cystectomy. In cases of complete remission, patients can maintain their bladders but they should be closely followed over years. The risk of severe late-radiation sequelae is low, in the range of less than 5%. About 75% of long-term survivors maintain a normally functioning bladder.

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Invasive bladder cancer:A single-institution experience with bladder-sparing approach

Cited by 23 publications

References 29 publications

Comparison of sequential versus concurrent chemoradiation regimens in non-metastatic muscle-invasive bladder cancer

Comparison of sequential versus concurrent chemoradiation regimens in non-metastatic muscle-invasive bladder cancer

Bladder sparing surgery in high-grade bladder cancer

Bladder preservation in muscle‐invasive bladder cancer by conservative surgery and radiochemotherapy

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