Nordic Prospective Trials of Radical Cystectomy and Neoadjuvant Chemotherapy

Hellsten, Sverker; Rintala, Erkki; Wahlqvist, Rolf; Malmström, Per‐Uno

doi:10.1159/000052263

Cited by 13 publications

(6 citation statements)

References 7 publications

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“…The mortality rate after RC has decreased during the last 10–20 years; it was reported to be 3.7% in the European Organization for Research and Treatment of Cancer – Medical Research Council trial [10], and in the Nordic Cystectomy trials I and II, it was 2.3% and 1.2%, respectively [11]. The mortality rate of 1% in the present study compares favourably with the previously reported series, and contradicts the notion that ONR results in a higher mortality rate.…”

Section: Discussionmentioning

confidence: 99%

A three‐centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients

et al. 2009

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OBJECTIVE To assess, in a retrospective three‐centre series, a second analysis of the initial experience and results of patients undergoing radical cystectomy (RC) and orthotopic neobladder reconstruction (ONR) after an additional 4 years of follow‐up. PATIENTS AND METHODS The medical records of 104 suitable consecutive patients undergoing RC and ONR between June 1994 and April 2003 were reviewed retrospectively. The complications, mortality, continence and cancer control rates were all recorded. RESULTS The median (range) follow‐up was 88 (52–156) months; 90 patients had reconstruction with a ‘Studer’ neobladder, 12 with a Hautmann W pouch and 2 with a ‘T pouch’ ileal neobladder. There were 24 early complications, and one death after surgery. There were 32 late complications. The daytime continence rate was 98% and the nocturnal continence rate was 76%. Ten patients required intermittent self‐catheterization (ISC). In all, 30 patients had local and/or distant recurrences, all of whom died. Seven patients died from other causes. CONCLUSIONS ONR provides excellent long‐term continence rates and both acceptable complication and mortality rates. Suitable patients undergoing RC should be offered ONR.

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Section: Discussionmentioning

confidence: 99%

A three‐centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients

et al. 2009

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“…Recent technical improvements in operative procedures and perioperative care have significantly reduced the morbidity and mortality rates for patients who underwent radical cystectomy. However, the long term efficacy of adjuvant or neoadjuvant therapy for patients who underwent cystectomy remains to be demonstrated 2–6, 30–39. In a review of 130 patients who underwent radical cystectomy for bladder carcinoma, Soloway et al2 found no significant survival advantage for those who received adjuvant therapy compared with those patients of similar stage who received conservative follow‐up treatment after surgery; however, Stockle et al found that adjuvant chemotherapy significantly improved progression free and all‐cause survival for patients who underwent radical cystectomy for locally advanced bladder carcinoma 32.…”

Section: Discussionmentioning

confidence: 99%

Predicting the survival of bladder carcinoma patients treated with radical cystectomy

Liu

Weaver

Leibovich

et al. 2000

Cancer

137

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BACKGROUND Clinical outcomes vary for patients treated with radical cystectomy. The authors sought to identify factors associated with the survival of patients treated with radical cystectomy for urothelial carcinoma of the urinary bladder. METHODS The authors studied 218 patients treated with radical cystectomy for urothelial carcinoma between 1980 to 1984. Patient ages ranged from 41 to 78 years (mean, 64 years). Using the 1997 TNM system, T classifications were Ta (17 patients), T1 (44), T2 (71), T3a (42), T3b (14), T4a (28), and T4b (2). Thirty‐two patients had lymph node metastasis at the time of surgery. Histologic grade was determined according to the newly proposed World Health Organization and International Society of Urological Pathology grading system; tumor was low grade in 43 patients and high grade in 175. The male‐to‐female ratio was 4.9 to 1. The mean follow‐up of patients still alive was 13.1 years (median, 13.8 years; range, 30 days to 18 years). Cox proportional hazards models were used to determine the impact of numerous clinical and pathologic findings on survival. RESULTS Ten‐year local recurrence free, distant metastasis free, cancer specific, and all‐cause survival were 71%, 73%, 67%, and 41%, respectively. In univariate analysis, cancer size, T classification, and lymph node status were associated with distant metastasis free, cancer specific, and all‐cause survival. Histologic grade and surgical margin status were significantly associated with worse cancer specific and all‐cause survival, but not with distant metastasis free survival. In multivariate analysis, cancer size, margin status, T classification, and lymph node status were identified as significantly associated with cancer specific survival after adjustment for age and gender. CONCLUSIONS Long term survival is achieved in a significant number of patients treated with radical cystectomy. In this study, patients with organ‐confined (≤ pT2) and small size (≤ 3 cm) cancer had favorable 10‐year distant metastasis free (93%) and cancer specific survival (88%) after cystectomy. Tumor size, margin status, extravesical involvement, and lymph node metastasis are important pathologic factors and should be considered as stratification variables in identifying patients for whom adjuvant chemotherapy should be evaluated in clinical trials. Cancer 2000;88:2326–32. © 2000 American Cancer Society.

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“…Die externe Radiotherapie, welche in wenigen europäi-schen Ländern und Kanada auch als primäre Therapie des lokal begrenzten Urothelkarzinoms (T1-4, N0, M0) in kurativer Absicht propagiert wurde [31][32][33][34][35][36][37][38][39][40][41][42][43][44], wird in den meisten Ländern nur bei lokal fortgeschrittenen Tumoren oder in rein palliativer Absicht eingesetzt. Ein begleitendes CIS erweist sich häufig als strahlenresistent.…”

Section: Nachsorge Nach Radikaler Zystektomieunclassified

“…Mögliche Komplikationen sind Stomaenge und rezidivierende Pyelonephritiden, weshalb häufig ein Ureterkatheter zur Schienung belassen werden muss. Generell lässt sich sagen, dass die langfristige Lebensqualität nach Ileum-Conduit, kontinentem Pouch oder orthotopem Blasenersatz ausgesprochen gut ist[32].Die operative Mortalität der radikalen Zystektomie mit den verschiedenen Harnableitungen liegt zwischen 1,2 %[33] und 3,7 %[34], die in der Regel passagere Frühmorbidität beträgt circa 30 %. Die Spätmorbidität steht zumeist in Zusammenhang mit der Harnableitung.…”

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Therapie und Nachsorge bei malignen Blasentumoren

Meyer

Schmid

Engeler

2007

Wien Med Wochenschr

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Treatment and follow up of bladder cancer strongly depends on stage and differentiation of the tumour. Superficial bladder tumours can mostly be controlled by transurethral resection followed by early intravesical application of a chemotherapeutic agent and a further close meshed follow-up. Generally, for muscle-invasive tumours radical cystectomy is indicated, whereas organ-spearing treatment due to combined therapeutic concepts can be offered in selected cases. For advanced and metastatic tumours, despite good response of bladder cancer to chemotherapy, prognosis is still poor. However, implementation of new chemotherapeutic agents indicate a trend towards improved survival rates.

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Nordic Prospective Trials of Radical Cystectomy and Neoadjuvant Chemotherapy

Cited by 13 publications

References 7 publications

A three‐centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients

A three‐centre experience of orthotopic neobladder reconstruction after radical cystectomy: revisiting the initial experience, and results in 104 patients

Predicting the survival of bladder carcinoma patients treated with radical cystectomy

Therapie und Nachsorge bei malignen Blasentumoren

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