Outcome of patients with nonmetastatic muscle‐invasive bladder cancer not undergoing cystectomy after treatment with noncisplatin‐based chemotherapy and/or radiotherapy: a retrospective analysis

Abstract

Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle‐invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin‐based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin‐based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty‐nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin‐based chemotherapy (n = 25), carboplatin‐based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five‐year event‐free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression‐free survival, and 30 (SE = 8) for cancer‐specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5‐year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit‐for‐cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated.

Systematic Review and Meta-Analysis on the Efficacy of Chemotherapy with Transurethral Resection of Bladder Tumors as Definitive Therapy for Muscle Invasive Bladder Cancer

“…Two studies reported measures of comorbidity. The study by Bamias et al, [ 26 ] which was excluded from our meta-analysis, reported a median Charlson comorbidity score of 5, which is associated with a significantly elevated mortality rate in the perioperative setting, for their entire study group [ 30 ]. Among this group, patients receiving systemic chemotherapy + TURBT were only those deemed unfit for radical cystectomy.…”

“…Attempts to compare systemic chemotherapy regimens (carboplatin-based vs. cisplatin-based) were limited by a lack of power deriving from unbalanced subgroups. Of the four studies that used carboplatin-based regimens, one [ 26 ] included only patients who were deemed “unfit for radical cystectomy” and reported 20% overall survival at 5 years, [ 26 ] while the others either included patients who refused RC [ 9, 34 ] or did not specify the reason for bladder sparing, [ 23 ] and reported rates closer to the 72% 5-year survival estimated by this meta-analysis.…”

“…Some groups have published studies with the specific aim of reporting the outcomes of an MIBC cohort who receives TURBT and systemic chemotherapy together as definitive treatment, typically in a non-randomized comparison with a contemporary or historical cohort receiving RC following NAC and TURBT [ 9, 10, 15–17, 19–23, 34, 37 ]. Others present data on the definitive systemic chemotherapy plus TURBT cohort as one subset of a larger bladder sparing group that includes patients who received partial cystectomy, [ 11 ] radiotherapy, [ 26, 31, 33 ] or systemic chemotherapy alone [ 18, 27 ]. These studies are typically smaller, often case series from single institutions.…”

The New Age of -omics in Urothelial Cancer – Re-wording Its Diagnosis and Treatment

“…The annual crude incidence rate is 20.4/100000, while in 2012, the annual crude mortality rate was 7.1/100,000. Most cases present with non-invasive disease, but about one third of these patients will progress to muscle-invasive disease, while 30% exhibit muscle invasion with or without metastases upon diagnosis ( Howlader et al, 2016 ; Bamias et al, 2016 ). Radical cystectomy (RC) with pelvic lymph node dissection (LND) is the treatment of choice ( Bellmunt et al, 2014 ).…”