Local control of muscle-invasive bladder cancer: Preoperative radiotherapy and cystectomy versus cystectomy alone

Cole, Christopher J.; Pollack, Alan; Zagars, Gunar K.; Dinney, Colin P.N.; Swanson, David A.; Eschenbach, Andrew C. von

doi:10.1016/0360-3016(94)90706-4

Cited by 6 publications

(10 citation statements)

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“…LF as the first evidence of recurrent disease for patients who have extravesical disease or positive lymph nodes in the University of Ulm series, in which surveillance pelvic CT scanning was used, can be estimated from data in the article at approximately 31% . The University of Texas MD Anderson Cancer Center experience in clinically staged patients, most of whom received chemotherapy, revealed 5‐year LF rates after RC of 29% and 44%, respectively for patients with clinical T3b (cT3b) and cT4 disease . In an international trial of neoadjuvant chemotherapy for muscle‐invasive bladder cancer, the subset of patients who had RC had a locoregional recurrence rate of approximately 40%…”

Section: Discussionmentioning

confidence: 99%

Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710

Christodouleas

Baumann

et al. 2014

Cancer

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BACKGROUND: Clinical trials of radiation after radical cystectomy (RC) and chemotherapy for bladder cancer are in development, but inclusion and stratification factors have not been clearly established. In this study, the authors evaluated and refined a published risk stratification for locoregional failure (LF) by applying it to a multicenter patient cohort. METHODS: The original stratification, which was developed using a single-institution series, produced 3 subgroups with significantly different LF risk based on pathologic tumor (pT) classification and the number of lymph nodes identified. This model was then applied to patients in Southwest Oncology Group (SWOG) 8710, a randomized trial of RC with or without chemotherapy. LF was defined as any pelvic failure before or within 3 months of distant failure. RESULTS: Patients in the development cohort and the SWOG cohort had significantly different baseline characteristics. The original risk model was not fully validated in the SWOG cohort, because lymph node yield was not as strongly associated with LF as in the development cohort. Regression analysis indicated that margin status could improve the model. A revised stratification using pT classification, margin status, and the number of lymph nodes identified produced 3 subgroups with significantly different LF risk in both cohorts: low risk (pT2), intermediate risk (pT3 with negative margins AND 10 lymph nodes identified), and high risk (pT3 with positive margins OR <10 lymph nodes identified) with 5-year LF rates of 8%, 20%, and 41%, respectively, in the SWOG cohort and 8%, 19%, and 41%, respectively, in the development cohort. CONCLUSIONS: A model incorporating pT classification, margin status, and the number of lymph nodes identified stratified LF risk in 2 different RC populations and may inform the design of future trials. Cancer 2014;120:1272-80. V C 2014 American Cancer Society.KEYWORDS: bladder cancer, urothelial cancer, local failure, adjuvant radiation. INTRODUCTIONPatients with muscle-invasive bladder cancer who undergo radical cystectomy plus bilateral pelvic lymphadenopathy (RC) with or without the receipt of perioperative chemotherapy have an estimated 5-year overall survival rate of approximately 50%.1 Although considerable attention has been given to the problem of distant relapse after RC, approximately 33% of patients with pT3 tumors develop a recurrence within the pelvis, either as isolated locoregional failures (LF) or cosynchronous with distant metastases.2 Several organizations are now considering clinical trials to assess the impact of radiation therapy (RT) after RC. However, criteria for the selection and stratification of patients most likely to benefit from adjuvant RT in these trials have not been clearly defined. A LF risk-stratification model derived from a single-institution experience has recently been published but not externally validated. 3 The purpose of this study was to assess the validity of this LF stratification model within the Southwest Oncology Group (SWOG) 8710 datab...

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Section: Discussionmentioning

confidence: 99%

Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710

Christodouleas

Baumann

et al. 2014

Cancer

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“…Cole et al. [17] showed that local relapses were more common than previously thought. As advanced imaging techniques become more accessible, there is an increase in the diagnosis of recurrences.…”

Section: Discussionmentioning

confidence: 95%

“…Bladder cancer is the second most common urological cancer following prostate cancer [9–17]. A total of 20–40% patients have the invasive disease even at the time of diagnosis [2,4].…”

Section: Discussionmentioning

confidence: 99%

Local and systemic recurrence patterns of urothelial cancer after radical cystectomy

Özbir

Girgin

Kara

et al. 2014

The Kaohsiung J of Med Scie

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The aim of this study was to evaluate the local recurrence and distant metastasis rates for urothelial carcinoma of the bladder after radical cystectomy and to identify the predictive factors for local recurrence and distant metastasis. The study population was 347 consecutive patients treated with radical cystectomy for urothelial carcinoma of the bladder at our institution. Local recurrence, distant metastasis, and both local and distant recurrence rates were 49 (14.1%) months, 96 (27.7%) months, and 17 (4.9%) months, respectively. The mean follow-up times to recurrence were 14.37 ± 13.25 months (range, 2-60 months) and 14.43 ± 15.72 months (range, 2-109 months) for local recurrence and distant metastasis, respectively (p = 0.808). The mean post-recurrence disease-specific survival (PRDSS) times for local, distant, and both local and distant recurrences were 17.82 ± 3.18 months, 4.16 ± 0.39 months, and 11.41 ± 2.73 months, respectively (p < 0.001). The predictive factors for local recurrence and distant metastasis were stage and nodal involvement (p < 0.001). Sex, grade, lymphovascular invasion (LVI), carcinoma in situ (CIS), and lymph node density (LND; 10% cut-off value) were not predictors for recurrence in the results of the multivariate analysis. The current study demonstrated that stage and pathological nodal involvement were independent predictors of local recurrence and distant metastasis. The results of this study suggest that the early diagnosis and intervention of invasive bladder cancer cases may decrease the number of high stage and lymph node positive cases that have a high risk of local and distant recurrences. The adjuvant treatment options in the presence of risk factors for recurrence may improve survival outcomes.

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“…Prowadzone od lat 60. badania nad zastosowaniem przedoperacyjnej radioterapii nie pozwoliły jednoznaczne wykazać jej istotnego wpływu na wyniki leczenia [41,42]. Jedynie w podgrupie z zaawansowaniem T3b, po napromienianiu przed radykalną cystektomią dawką całkowitą ok. 50 Gy, klasycznie frakcjonowaną, obserwowano istotną poprawę kontroli miejscowej, bez znamiennego wpływu na przeżycia całkowite i przeżycia bez przerzutów odległych [41].…”

Section: Neoadiuwantowe Leczenie Napromienianiemunclassified

“…Jedynie w podgrupie z zaawansowaniem T3b, po napromienianiu przed radykalną cystektomią dawką całkowitą ok. 50 Gy, klasycznie frakcjonowaną, obserwowano istotną poprawę kontroli miejscowej, bez znamiennego wpływu na przeżycia całkowite i przeżycia bez przerzutów odległych [41].…”

Section: Neoadiuwantowe Leczenie Napromienianiemunclassified

Rola teleradioterapii w inwazyjnym raku pęcherza moczowego

Nowak-Sadzikowska¹,

Jakubowicz²

2014

Nowotwory. Journal of Oncology

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Radykalna cystektomia jest leczeniem z wyboru u chorych na inwazyjnego, naciekającego mięśniówkę właściwą raka pęcherza moczowego. Obok chirurgii teleradioterapia stanowi podstawową metodę radykalnego leczenia chorych na inwazyjnego raka pęcherza moczowego. Skojarzone leczenie zachowawcze: TURB, radioterapia i chemioterapia, pozwala na uzyskanie 5-letnich przeżyć całkowitych, wahających się od 50% do 63%, przy zachowaniu u około trzech czwartych chorych prawidłowo funkcjonującego pęcherza. Wyniki radykalnego zachowawczego leczenia miejscowego: TURB z następową samodzielną teleradioterapią są niezadowalające, a 5-letnie przeżycia całkowite wynoszą od 20% do 40%. Prowadzone są liczne badania kliniczne mające na celu poprawę skuteczności napromieniania chorych na inwazyjnego raka pęcherza moczowego poprzez: podwyższanie całkowitej dawki, modyfikowanie obszaru napromienianego, stosowanie niekonwencjonalnych metod frakcjonacji, stosowanie hipertermii, podawanie środków radiouczulających. Samodzielna teleradioterapia jako leczenie radykalne inwazyjnego raka pęcherza moczowego jest obecnie zalecana jedynie w przypadku chorych niezakwalifikowanych do leczenia operacyjnego lub niewyrażających zgody na operację, równocześnie niekwalifikujących się do leczenia systemowego. Biorąc pod uwagę fakt, że rak pęcherza moczowego jest nowotworem pacjentów w starszym wieku, jak również ciągłe starzenie się naszej populacji, samodzielna radioterapia może stanowić jedyną formę leczenia stwarzającą szansę na wyleczenie z inwazyjnego, naciekającego raka pęcherza moczowego w stosunkowo licznej grupie chorych. Rola uzupełniającej radioterapii w stosunku do radykalnej i częściowej cystektomii wymaga oceny w wielośrodkowych randomizowanych badaniach klinicznych. Role of external radiation therapy in invasive bladder cancerRadical cystectomy is the treatment of choice for patients with muscle-invasive bladder cancer. Radiotherapy, as well as surgery are essential methods of treatment of invasive bladder cancer. Combined modality bladder-sparing treatment can achieve 5-year overall survival rates of 50-63%, and with some 75% of surviving patients maintaining their bladder. For local treatment alone, radiation therapy following TURB, has resulted in 5-year survival rates of 20-40%. Many studies have been performed to improve the results of radiotherapy in the treatment of invasive bladder cancer by escalation of total dose, adoption of altered fractionation, modification of treatment volume, application of hyperthermia or using radiosensitizers. Radical radiotherapy following TURB should be used only in patients who are not surgical candidates or who have refused surgery and are not suitable for chemotherapy. Since bladder cancer is a disease of an elderly and aging population, definitive radiotherapy can be only one possibility for radical treatment for relatively large number of patients with muscle-invasive bladder cancer. Preoperative or postoperative radiotherapy following radical or partial cystectomy need further evaluation in multicent...

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Local control of muscle-invasive bladder cancer: Preoperative radiotherapy and cystectomy versus cystectomy alone

Cited by 6 publications

References 0 publications

Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710

Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710

Local and systemic recurrence patterns of urothelial cancer after radical cystectomy

Rola teleradioterapii w inwazyjnym raku pęcherza moczowego

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