Outcomes of Radical Cystectomy in Potential Candidates for Bladder Preservation Therapy

Pietzak, Eugene J.; Sterling, Matthew; Smith, Zachary L.; Malkowicz, S. Bruce; Guzzo, Thomas J.

doi:10.1016/j.urology.2015.01.001

Cited by 18 publications

(5 citation statements)

References 27 publications

(47 reference statements)

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“…Despite intensified research, there is a persistent lack of clinical useful biomarkers for patient selection, as all reported results are still exploratory [47][48][49][50][51][52][53]. So far, as seen in patients undergoing primary RC, there remains a substantial risk for understaging even in patients seemingly ideal for BST [54][55][56]. As LND remains the most accurate method for complete pathological staging and thus for detection of more aggressive tumors while simultaneously treating micrometastases, neoadjuvant chemotherapy followed by RC and LND is likely to remain the gold standard for treatment of MIBC in cisplatin and surgically fit patients, as it allows the best risk stratification [57].…”

Section: Discussionmentioning

confidence: 99%

Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

et al. 2020

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Objective We conducted a systematic review and meta-analysis to assess the available literature regarding the surgical and oncologic outcomes of patients undergoing salvage radical cystectomy (SV-RC) for recurrence or failure of bladder sparing therapy (BST) for muscle-invasive bladder cancer (MIBC). Methods We searched MEDLINE (PubMed), EMBASE and Google Scholar databases in May 2020. We included all studies of patients with ≥ cT2N0/xM0 bladder cancer that were eligible for all treatment modalities at the time of treatment decision who underwent BST including radiotherapy (RTX). A meta-analysis was conducted to calculate the pooled rate of several variables associated with an increased need for SV-RC. Study quality and risk of bias were assessed using MINORS criteria. Results 73 studies comprising 9110 patients were eligible for the meta-analysis. Weighted mean follow-up time was 61.1 months (range 12–144). The pooled rate of non-response to BST and local recurrence after BST, the two primary reasons for SV-RC, was 15.5% and 28.7%, respectively. The pooled rate of SV-RC was 19.2% for studies with a follow-up longer than 5 years. Only three studies provided a thorough report of complication rates after SV-RC. The overall complication rate ranged between 67 and 72% with a 30-day mortality rate of 0–8.8%. The pooled rates of 5 and 10-year disease-free survival after SV-RC were 54.3% and 45.6%, respectively. Conclusion Approximately one-fifth of patients treated with BST with a curative intent eventually require SV-RC. This procedure carries a proportionally high rate of complications and is usually accompanied by an incontinent urinary diversion.

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Section: Discussionmentioning

confidence: 99%

Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis

et al. 2020

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“…Even though the BC2001 trial did not include patients with clinical node positive disease, chances of occult metastasis in radiological node negative disease exist. For instance, in a surgical series of radical cystectomy in cT2N0 bladder urothelial cancers, occult positive lymph nodes were found in 24% of patients [ 38 ]. Unplanned inclusion of pelvic lymph nodes in the planning target volume may explain the low rate of lymph node recurrence.…”

Section: Pelvic Nodal Irradiation In Bladder Cancermentioning

confidence: 99%

Bladder Preservation for Muscle Invasive Bladder Cancer

Mirza

Choudhury

2016

BLC

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The standard treatment for muscle invasive bladder cancer (MIBC) has been considered to be radical cystectomy (RC) with pelvic lymphadenectomy. However morbidity and impact on quality of life is significant. Radiotherapy has been used in MIBC patients who choose bladder preservation or who are unfit for RC with comparable outcomes. Evidence from some prospective and large retrospective series supports the use of radiotherapy as an attractive alternative option. In this paper we review the evidence and practice of bladder preservation strategies with radiotherapy for muscle invasive bladder cancer.

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“…11 Not surprisingly, BPT-eligible patients had superior overall (OS) and cancer specific survival (CSS) at 2 years relative to BPTineligible patients. 11 Interestingly, progression from non-invasive disease in BPT-eligible patients was independently associated with upstaging on RC pathology. 11…”

Section: Patient Selection For Bpt Protocolsmentioning

confidence: 99%