Muscle-invasive bladder cancer treated with external beam radiotherapy: pretreatment prognostic factors and the predictive value of cystoscopic re-evaluation during treatment

Moonen, L.; Voet, H. van der; Nijs, Roland de; Hart, A. A. M.; Horenblas, Simon; Bartelink, Harry

doi:10.1016/s0167-8140(98)00089-9

Cited by 28 publications

(16 citation statements)

References 14 publications

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“…32,33 However, to our knowledge, the prognostic significance of a PR or a CR as assessed cystoscopically after 40 Gy is questionable. The results of the current study appear to confirm the observation of Moonen et al 34 They reported that local control in patients who underwent a cystoscopic evaluation during RT was identical regardless of whether a CR, PR, or no response had been observed. Furthermore, a higher percentage of freedom from cystectomy (approximately 80%) was reported to be observed in studies in which combined treatment was administered without interruption for response assessment in respect to studies where response assessment was performed after 2 weeks of RCT (52-66%).…”

Section: Discussionsupporting

confidence: 91%

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

Danesi

Arcangeli²,

et al. 2004

Cancer

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BACKGROUNDOrgan preservation has been investigated in patients with muscle‐invasive bladder carcinoma over the past decades as an alternative to radical cystectomy. The majority of studies reported that trimodal schedules, including transurethral resection of bladder tumor (TURB), radiotherapy (RT), and chemotherapy, are a feasible and safe organ‐sparing approach without deferring the survival probability. However, to the authors' knowledge the best combination of RT and chemotherapy has yet to be well defined. The current study evaluated the long‐term results of a schedule of concurrent cisplatin and 5‐fluorouracil (5‐FU) administered as protracted intravenous infusions (PVI) during hyperfractionated radiotherapy (HFRT) with organ‐sparing intent in patients with infiltrating transitional cell carcinoma of the bladder (TCCB).METHODSSeventy‐seven patients with a classification of T2–T4aN0M0 TCCB were enrolled in the current study. After a complete TURB and bladder mapping, 42 of 77 patients underwent 2 cycles of induction chemotherapy. All 77 patients underwent HFRT and a schedule of cisplatin (4–6 mg/m2 per day) and 5‐FU (180–220 mg/m2 per day) as concomitant PVI (radiochemotherapy [RCT]). Six to 8 weeks after RCT, patient response was evaluated by computed tomography scan, urine cytology, and TURB. Patients who achieved a complete response (CR) were followed at regular intervals. For patients with residual or recurrent invasive tumor, salvage cystectomy was recommended.RESULTSSeventy‐two patients were evaluable for response: 65 achieved a CR (90.3%) and 7 (9.7%) achieved a partial response. No significant difference was observed for the different prognostic factors with the exception of stage of disease (T2 [95.7%] vs. T3–T4a [80.0%]; P = 0.04). The observed toxicity, mainly hematologic, was higher among the patients who received induction chemotherapy compared with the patients who did not receive induction chemotherapy, even though the difference was not statistically significant. After a median follow‐up of 82.2 months (range, 30–138 months), 44 of 65 (57.1%) patients who achieved a CR were alive. Of these 44 patients, 33 had tumor‐free bladders. The 5‐year overall, bladder‐intact, tumor‐specific, disease‐free, and cystectomy‐free survival rates for all 77 patients were 58.5%, 46.6%, 75.0%, 53.5%, and 76.1%, respectively. No associations were observed in overall and tumor‐specific survival with different prognostic factors.CONCLUSIONSCombined treatment appeared to provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients who refuse or are unsuitable for surgery. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionsupporting

confidence: 91%

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

Danesi

Arcangeli²,

et al. 2004

Cancer

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“…In this series, there was a weak correlation between the Ki-67 index and local control. Other studies that have used Ki-67 as a marker of proliferation in transitional cell bladder cancer have reported a significantly lower progression-free and disease-specific survival rates in patients with higher Ki-67 indices (Popov et al, 1997;Lara et al, 1998;Moonen et al, 1998a;Rodel et al, 2000). Clinical data relating the effect of treatment duration on bladder outcome are equivocal (Maciejewski and Majewski, 1991;De Neve et al, 1995;Moonen et al, 1998b).…”

Section: P=00021mentioning

confidence: 99%

GLUT1 and CAIX as intrinsic markers of hypoxia in bladder cancer: relationship with vascularity and proliferation as predictors of outcome of ARCON

et al. 2003

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Glucose transporter-1 protein (GLUT1) and carbonic anhydrase IX (CAIX) are regulated by hypoxia inducible factor-1 (HIF-1) and have been studied as putative intrinsic cellular markers for hypoxia. This study directly compares CAIX and GLUT1 with pimonidazole binding in a prospective series of bladder cancer patients and also studies the prognostic significance of the markers, in combination with vascularity and proliferation, in a retrospective series of bladder cancer patients treated in a phase II trial of radical radiotherapy with carbogen and nicotinamide (ARCON). A total of 21 patients with a diagnosis of transitional cell carcinoma of the bladder received 0.5 g m À2 pimonidazole. Serial tumour sections were stained for pimonidazole, GLUT1 and CAIX and compared. Tissue sections obtained from a series of 64 patients previously treated for invasive bladder cancer using ARCON were stained for GLUT1 and CAIX together with Ki-67 and CD31/34. There was a good geographical colocalisation of both intrinsic markers with pimonidazole and a highly significant agreement in individual patients; correlation coefficients were 0.82 (P ¼ 0.0001) for GLUT1 and 0.74 (Po0.0001) for CAIX. In both series of patients, the intrinsic hypoxia markers were highly correlated with each other and a correlation with proliferation was also evident in the retrospective study. In univariate and multivariate analyses, GLUT1 and CAIX were independent predictors for overall and cause specific survival. The hypoxia markers did not predict for local control or metastases-free survival although higher Ki-67 indices showed a trend towards local failure. The data suggest that both hypoxia modification and accelerated treatment may be valid treatment options in bladder cancer.

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“…For conventional radiotherapy, local control rates of 15-45% have been described [19,32]. Recently, local control rates up to 65% have been reported with accelerated or hyperfractionated radiotherapy [7,41].…”

Section: Introductionmentioning

confidence: 99%

Clinical Results of a Concomitant Boost Radiotherapy Technique for Muscle-Invasive Bladder Cancer

et al. 2008

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Muscle-invasive bladder cancer treated with external beam radiotherapy: pretreatment prognostic factors and the predictive value of cystoscopic re-evaluation during treatment

Cited by 28 publications

References 14 publications

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

GLUT1 and CAIX as intrinsic markers of hypoxia in bladder cancer: relationship with vascularity and proliferation as predictors of outcome of ARCON

Clinical Results of a Concomitant Boost Radiotherapy Technique for Muscle-Invasive Bladder Cancer

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