Neoadjuvant Chemotherapy Before Bladder-Sparing Chemoradiotherapy in Patients With Nonmetastatic Muscle-Invasive Bladder Cancer

Jiang, Di; Jiang, Haiyan; Chung, Peter; Zlotta, Alexandre R.; Fleshner, Neil; Bristow, Robert G.; Berlin, Alejandro; Kulkarni, Girish S.; Alimohamed, Nimira; Lo, Gregory; Sridhar, Srikala S.

doi:10.1016/j.clgc.2018.09.021

Cited by 33 publications

(20 citation statements)

References 43 publications

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“…Some of the treatment results in the literature are better than those reported by us. However, it should be emphasized that those groups were composed of more favorable patients with muscle-invasive bladder cancer which should be rather compared with our CCRT group (16,23,24). For instance, very good results were observed in a retrospective study by Perdona et al (24) (5-year: OS=67.7%, LC=56.3%).…”

Section: Discussionmentioning

confidence: 80%

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Bladder-conserving Approach in Radical Treatment of Patients With Bladder Cancer – A Single-institution Experience

et al. 2020

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Aim: To evaluate our experience with radical radiotherapy and chemotherapy in patients with muscleinvasive bladder cancer. Patients and Methods: The study consisted of 27 patients treated with cisplatin-based chemoradiation (CCRT), 48 treated with radiation alone (RT), and 42 with locally advanced disease treated with neoadjuvant chemotherapy and radiation (neoCRT). Results: The incidence of acute grade 3 or more genitourinary (GU) toxicity in the RT, CCRT and neoCRT groups was: 25%, 11% and 19%, respectively (p=0.029). The 3-year freedom from grade 2 or more GU toxicity was: 81%, 89%, 54%, respectively (p=0.36). The long-term outcomes of 3-year local control, overall survival, and disease-free survival were as follows: RT group: 74%, 61% and 55%; CCRT group: 76%, 76% and 56%; neoCRT group: 31%, 43% and 18%, respectively. Conclusion: The preferable bladder-conserving approach is CRT, however RT alone might also be an option for appropriately selected patients. NeoCRT for those with locally advanced tumors remain unsatisfactory; adequate selection of patients for radical treatment is of importance.

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Section: Discussionmentioning

confidence: 80%

“…On the other hand, such patient suitability for upfront radical treatment and expectations towards long-term survival may be questionable. In contrast, the vast majority of patients with less advanced stages complete neoadjuvant chemotherapy and subsequent RT successfully (23,24).…”

Section: Discussionmentioning

confidence: 99%

Bladder-conserving Approach in Radical Treatment of Patients With Bladder Cancer – A Single-institution Experience

et al. 2020

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“…26 Jiang et al showed that when gemcitabine and cisplatin neoadjuvant chemotherapy were given for 2 to 4 cycles prior to BCT, patients had 2-year overall survival of 74%. 58 Furthermore, Tester et al used two cycles of neoadjuvant methotrexate, cisplatin and vinblastine (MCV) prior to BCT and also showed that overall survival is similar to that reported with surgical approaches. 59 Thompson et al also showed patients treated with neoadjuvant chemotherapy followed by BCT with gemcitabine had manageable toxicity and acceptable treatment completion rates.…”

Section: Guideline 9: Systemic Agents To Use In Bctmentioning

confidence: 80%

“…Neoadjuvant chemotherapy has been shown to have encouraging results in these patients. 58 Previous contouring guidelines suggest bilateral uninvolved nodes should receive in the order of 45Gy to 50.40 Gy in 1.80 Gy fractions. 64 Elective nodal irradiation (ENI) is controversial and remains optional in node negative patients.…”

Section: Guideline 10: Management Of Pelvic Nodesmentioning

confidence: 99%

FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC

et al. 2020

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“…Meta-analyses suggest NAC improves survival outcomes regardless of whether patients received TMT or surgery, although differences were not statistically significant [90,125]. Investigators at the Princess Margaret Cancer Centre and other centres recently reported encouraging outcomes and tolerability of NAC prior to TMT [126,127]. It is important to note that historically TMT was reserved for patients who were ineligible for RC (and often ineligible for cisplatin-based NAC).…”

Section: Neoadjuvant Chemotherapy (Nac)mentioning

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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Neoadjuvant Chemotherapy Before Bladder-Sparing Chemoradiotherapy in Patients With Nonmetastatic Muscle-Invasive Bladder Cancer

Cited by 33 publications

References 43 publications

Bladder-conserving Approach in Radical Treatment of Patients With Bladder Cancer – A Single-institution Experience

Bladder-conserving Approach in Radical Treatment of Patients With Bladder Cancer – A Single-institution Experience

FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC

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

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