Long-term Outcomes and Patterns of Failure Following Trimodality Treatment With Bladder Preservation for Invasive Bladder Cancer

Büchser, D.; Zapatero, A.; Rogado, Jacobo; Talaya, M.S.; Vidales, C. Martín de; Arellano, R.; Bocardo, Gloria; Conde, A. Cruz; Pérez, Leopoldo; Murillo, M.T.

doi:10.1016/j.urology.2018.07.058

Cited by 17 publications

(9 citation statements)

References 31 publications

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“…James et al 11 first reported that TURBT combined with postoperative chemotherapy, nearly one-third of patients benefitted from the degradation of TNM staging. Büchser et al 2 conclude that the bladder preservation rate could reach up to 79% and the 5-year OS and PFS were 52% and 64% within 10 years under the strategy of TMT, which was made up of cTURBT and chemoradiotherapy. A prospective study also found that the complete response rate after TMT was 69% and the 5-year OS and PFS were 57% and 71%, and the outcomes were similar to that of RC.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Radical cystectomy (RC) is known as the standard treatment for muscle-invasive bladder cancer (MIBC). 2 However, this procedure is highly invasive and risky, and has a significant impact on the quality of life of the patients. 3 A combined modality therapy that maximizes the preservation of bladder function without compromising oncotherapy is an alternative that may be considered.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Tri-Modality Therapy with Bladder Preservation for Selective Muscle-Invasive Bladder Cancer

Zhang

Zhou

Song

et al. 2021

Technol Cancer Res Treat

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Objectives: To compare the efficacy of complete transurethral resection of bladder tumor combined with postoperative chemoradiotherapy and radical cystectomy (RC) in the treatment of muscle-invasive bladder cancer (MIBC). Methods: This is a single-center, retrospective study. Clinical data of 125 patients with MIBC admitted to the First Affiliated Hospital of Soochow University from December 2012 to December 2015 were retrospectively analyzed, in which 79 patients (tri-modality therapy [TMT] group) received TMT bladder-sparing treatment, and 41 patients (RC group) received RC. The differences of probabilities for 1-year, 2-year, 5-year, and comprehensive overall survival (OS), progress-free survival (PFS) between 2 groups were calculated using Kaplan–Meier product limited estimates. Univariate and multivariate analyses were performed to detect potential risk factors for OS and PFS. Results: There was no statistical difference between the TMT group and RC group in the 1-year, 2-year, 5-year, comprehensive OS rate, and PFS rate. And survival analysis found no significant difference in OS and PFS between the 2 groups. Univariate analysis showed that age, TNM staging, and prognostic nutritional index (PNI) were associated with OS, while PNI was connected to tumor recurrence. Multiple linear regression analysis indicated that TNM staging and PNI were independent risk factors for OS. Conclusions: TMT can be used as an alternative to RC for MIBC patients under the premise of strict control of indications, rigorous postoperative follow-up, and timely salvage cystectomy. PNI was negatively correlated with OS and PFS, while TNM staging was positively correlated with OS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Tri-Modality Therapy with Bladder Preservation for Selective Muscle-Invasive Bladder Cancer

Zhang

Zhou

Song

et al. 2021

Technol Cancer Res Treat

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“…Comparisons were performed with the log-rank test OS overall survival, CSS cancer specific survival, RT radiation therapy, CRT chemoradiotherapy, n. r. not reached, 1a one-year, 2a two-year, 3a three-year A p-value below 0.05 was considered statistically significant. Comparisons were performed with the log-rank test LC local control, DC distant control, n. r. not reached, n. s. not significant, RT radiation therapy, CRT chemoradiotherapy, 1a one-year, 2a twoyear, 3a three-year tients presented with hydronephrosis at diagnosis, which is known to be a negative prognostic factor for patients with MIBC [34]. Fifth, one fourth of patients did not receive any chemotherapy at all, which is known to be less effective than concomitant CRT [10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer—a valid option for cisplatin-unfit patients?

et al. 2021

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Purpose Treatment of muscle-invasive bladder cancer (MIBC) remains challenging, especially for elderly and/or comorbid patients. Patients who are unfit for or refuse surgery should receive bladder-preserving multimodality treatment (BPMT), consisting of transurethral resection of the bladder tumor (TURB) followed by combined chemoradiotherapy (CRT). We aimed to investigate the effectiveness of vinorelbine, a chemotherapeutic agent not routinely used for MIBC, in patients referred to CRT who are unfit for standard chemotherapy and would thus rely solely on radiotherapy (RT). Methods We retrospectively analyzed 52 consecutive patients with MIBC who received standard CRT with cisplatin (n = 14), CRT with vinorelbine (n = 26), or RT alone (n = 12). Primary endpoints were median overall survival (OS) and median cancer-specific survival (CSS). Secondary endpoints were median local control (LC), median distant control (DC), and OS, CSS, LC, and DC after 1, 2, and 3 years, respectively. Results Median OS and CSS were significantly higher for patients who received vinorelbine as compared to RT alone (OS 8 vs. 22 months, p = 0.003; CSS 11 months vs. not reached, p = 0.001). Median LC and DC did not differ significantly between groups. Vinorelbine was well tolerated with no reported side effects >grade II. Conclusion Our results suggest that CRT with vinorelbine is well tolerated and superior to RT alone in terms of OS and CSS. Therefore, this treatment regime might constitute a new treatment option for patients with MIBC who are unfit for or refuse surgery or standard chemotherapy. This study encourages a randomized controlled trial to compare this new regime to current standard therapies.

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“…Ideal candidates for TMT are patients with 1) cT2 with tumors <5 cm [243], 2) solitary tumors without extensive carcinoma in situ (CIS) [244][245][246], 3) minimal to no hydronephrosis [124,247], 4) good bladder function [243], 5) completion of maximal TURBT without visible residual tumor [229,246,248,249], and 6) agreeable to long-term surveillance with regular cystoscopy and imaging [243]. TMT is likely equivalent to RC in these patients, as shown by data with long-term follow up [229,243,[250][251][252][253][254][255], and up to 89% of patients successfully retain their native bladders [243].…”

Section: Trimodality Therapy (Tmt)mentioning

confidence: 99%

“…Therefore, all patients require close cystoscopic surveillance post TMT. Based on published TMT surveillance protocols [123,243,248,252] and extrapolating from the NMIBC setting, cystoscopy and urine cytology are generally recommended every 3-6 months for the first three years followed by every 6 months for two additional years, and annually thereafter. Delayed local recurrence (or development of a new primary) at 10 years have been reported in up to 10% of patients following TMT, therefore long term cystoscopic surveillance may be warranted [250,252].…”

Section: Post-treatment Surveillancementioning

confidence: 99%

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

Jiang

North

Canil

et al. 2020

BLC

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BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.

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Long-term Outcomes and Patterns of Failure Following Trimodality Treatment With Bladder Preservation for Invasive Bladder Cancer

Cited by 17 publications

References 31 publications

The Effect of Tri-Modality Therapy with Bladder Preservation for Selective Muscle-Invasive Bladder Cancer

The Effect of Tri-Modality Therapy with Bladder Preservation for Selective Muscle-Invasive Bladder Cancer

Vinorelbine in bladder-preserving multimodality treatment for muscle-invasive bladder cancer—a valid option for cisplatin-unfit patients?

Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada

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