Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience

Giacalone, Nicholas J.; Shipley, William U.; Clayman, R.H.; Niemierko, Andrzej; Drumm, Michael; Heney, Niall M.; Michaelson, M. Dror; Lee, Richard J.; Saylor, Philip J.; Wszolek, Matthew F.; Feldman, Adam S.; Dahl, Douglas M.; Zietman, Anthony L.; Efstathiou, Jason A.

doi:10.1016/j.eururo.2016.12.020

Cited by 285 publications

(220 citation statements)

References 35 publications

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“…Incomplete resection is an unfavorable prognostic factor for the ability to preserve the bladder. [53][54][55] Radiation Therapy Oncology Group protocol 89-03 compared concurrent cisplatin and RT with or without 2 cycles of induction CMV. 52 No difference in complete clinical response or 5-year OS was observed between the treatment arms.…”

Section: Rt With Concurrent Chemotherapy Followingmentioning

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

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225

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: Rt With Concurrent Chemotherapy Followingmentioning

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

Self Cite

225

173

View full text Add to dashboard Cite

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“…The addition of neoadjuvant cisplatin-based chemotherapy prior to cystectomy improves overall survival compared to cystectomy alone [26,27]. Trimodality therapy (TMT), which consists of maximal transurethral tumor resection (TUR) followed by concurrent chemoradiotherapy, is an alternative to cystectomy and provides an opportunity for patients to maintain a functional bladder [28,29]. Given that the success of both approaches depends on the therapeutic efficacy of DNA damaging agents, there is significant interest in identifying predictive biomarkers to help guide the use of these agents in MIBC.…”

Section: Dna Repair Pathways Are Predictive Biomarkers In Bladder mentioning

confidence: 99%

DNA Repair Pathway Alterations in Bladder Cancer

Mouw

2017

Cancers

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Most bladder tumors have complex genomes characterized by a high mutation burden as well as frequent copy number alterations and chromosomal rearrangements. Alterations in DNA repair pathways—including the double-strand break (DSB) and nucleotide excision repair (NER) pathways—are present in bladder tumors and may contribute to genomic instability and drive the tumor phenotype. DNA damaging such as cisplatin, mitomycin C, and radiation are commonly used in the treatment of muscle-invasive or metastatic bladder cancer, and several recent studies have linked specific DNA repair pathway defects with sensitivity to DNA damaging-based therapy. In addition, tumor DNA repair defects have important implications for use of immunotherapy and other targeted agents in bladder cancer. Therefore, efforts to further understand the landscape of DNA repair alterations in bladder cancer will be critical in advancing treatment for bladder cancer. This review summarizes the current understanding of the role of DNA repair pathway alterations in bladder tumor biology and response to therapy.

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“…Previous studies reported that patients with surgically unresectable tumour and those who are medically inoperable have poor survival after trimodal bladder preservation therapy. The quite favourable oncological outcomes in the present study compared to landmark studies may be explained in part by the fact that our cohort mostly consisted of operable patients who are hoping for bladder preservation.…”

Section: Discussionmentioning

confidence: 70%

Selective tetramodal bladder‐preservation therapy, incorporating induction chemoradiotherapy and consolidative partial cystectomy with pelvic lymph node dissection for muscle‐invasive bladder cancer: oncological and functional outcomes of 107 patients

et al. 2019

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Objectives To evaluate the oncological and functional outcomes associated with selective tetramodal bladder‐sparing therapy, comprising maximal transurethral resection of bladder tumour (TURBT), induction chemoradiotherapy (CRT), and consolidative partial cystectomy (PC) with pelvic lymph node dissection (PLND). Materials and Methods In the present study, 154 patients with non‐metastatic muscle‐invasive bladder cancer (MIBC), prospectively enrolled in the tetramodal bladder‐preservation protocol, were analysed. After TURBT and induction CRT, patients showing complete remission were offered consolidative PC with PLND for the achievement of bladder preservation. Pathological response to induction CRT was evaluated using PC specimens. Oncological and functional outcomes after bladder preservation were evaluated using the following endpoints: MIBC‐recurrence‐free survival (RFS); cancer‐specific survival (CSS); overall survival (OS), and cross‐sectional assessments of preserved bladder function and quality of life (QoL) including uroflowmetry, bladder diary, International Prostate Symptom Score, Overactive Bladder Symptom Score and the 36‐item Short‐Form Health Survey (SF‐36) score. Results The median follow‐up period was 48 months. Complete MIBC remission was achieved in 121 patients (79%) after CRT, and 107 patients (69%) completed the tetramodal bladder‐preservation protocol comprising consolidative PC with PLND. Pathological examination in these 107 patients revealed residual invasive cancer (≥pT1) that was surgically removed in 11 patients (10%) and lymph node metastases in two patients (2%). The 5‐year MIBC‐RFS, CSS and OS rates in the 107 patients who completed the protocol were 97%, 93% and 91%, respectively. As for preserved bladder function, the median maximum voided volume, post‐void residual urine volume, and nighttime frequency were 350 mL, 25 mL, and two voids, respectively. In the SF‐36, patients had favourable scores, equivalent to the age‐matched references in all the QoL scales. Conclusion Selective tetramodal bladder‐preservation therapy, incorporating consolidative PC with PLND, yielded favourable oncological and functional outcomes in patients with MIBC. Consolidative PC may have contributed to the low rate of MIBC recurrence in patients treated according to this protocol.

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Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience

Cited by 285 publications

References 35 publications

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

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

DNA Repair Pathway Alterations in Bladder Cancer

Selective tetramodal bladder‐preservation therapy, incorporating induction chemoradiotherapy and consolidative partial cystectomy with pelvic lymph node dissection for muscle‐invasive bladder cancer: oncological and functional outcomes of 107 patients

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