Selective bladder conservation using transurethral resection, chemotherapy, and radiation: management and consequences of Ta, T1, and Tis recurrence within the retained bladder

Zietman, Anthony L.; Grocela, Joseph A.; Zehr, E; Kaufman, Donald S.; Young, Robert H.; Althausen, Alex F.; Heney, Niall M.; Shipley, William U.

doi:10.1016/s0090-4295(01)01219-5

Cited by 131 publications

(79 citation statements)

References 12 publications

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“…A majority of patients with complete pathological response retain their bladders free from invasive relapse, while about one-quarter will develop superficial recurrence. This may be managed in the standard fashion with transurethral resection of the bladder tumour and intravesical therapies (Zietman et al, 2001;Rödel et al, 2002b). The national randomised phase III trial, BC2001 launched in August 2001, will further define the role of synchronous chemoradiotherapy in muscle invasive bladder cancer.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

et al. 2004

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We conducted a phase I/II study investigating synchronous chemoradiotherapy with mitomycin C and infusional 5-fluorouracil (5-FU) in muscle invasive bladder cancer. Early dose escalation results were previously published. We report the long-term toxicity and efficacy results with the optimised regimen. Patients with muscle invasive bladder cancer with glomerular filtration rate 425 ml min À1 were eligible. Mitomycin (12 mg m À2 on day 1 only) and infusional 5-FU (500 mg m À2 day À1 ) for 5 days were administered during weeks 1 and 4 of radiotherapy of 55 Gy in 20 fractions. A total of 41 patients were enrolled, median age was 68 years, 33 were male and eight female patients. Out of the 41 patients, 20 (49%) had hydronephrosis at presentation and 25 (62%) had T3b or T4 disease. Four patients experienced Grade III thrombocytopenia and three patients had Grade III neutropenia. There were no episodes of febrile neutropenia. Four patients experienced Grade III diarrhoea and 1 Grade III urgency and dysuria. Six patients did not undergo cystoscopic evaluation due to early metastatic spread although there was no clinical suggestion of bladder failure. In all, out of 35 evaluable patients, 25 (71%) had macroscopic complete response at 3-month cystoscopy, and biopsy confirmed in 24 out of 25. A total of 16 (39%) patients remain alive with a median follow-up of 50.7 (range 23.5 -68.8) months, 14 with a functioning bladder with no reported long-term treatment-related bladder or bowel toxicity. Five out of 41 patients have undergone salvage cystectomy: two for persistent CIS, two T1 and one muscle invasive recurrence. Four patients have received intravesical chemotherapy, of whom two remain alive with a functioning bladder. Overall 12-, 24-and 60-month (m) survival rates were 68, 49 and 36%. Local and distant progression free rates were 82 and 86% at 12-m and 79 and 75% at 24-m. Organ preservation using multimodality therapy is feasible and safe, even in patients with poor renal reserve, and does not compromise salvage therapies. A national phase III trial BC2001 (www.bc2001.org.uk) exploring the effects of synchronous chemoradiotherapy with this regimen is currently recruiting.

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Section: Discussionmentioning

confidence: 99%

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

et al. 2004

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“…215 Patients must have close and lifelong cystoscopic surveillance of their bladders, with prompt cystectomy for those who develop invasive recurrence. 216 Critics of organ conservation argue that bladder cancer causes a field change that affects the entire transitional epithelium and exposes patients to multiple tumors arising in both space and time. 216 Zietman et al, however, looked at 121 patients who had a complete response with trimodality therapy and found that the majority of these patients retained their bladders free from relapse; of the 25% who experienced a nonmuscle-invasive relapse, the irradiated bladders tolerated TURBT and intravesical therapies well, with complete response rates comparable to patients with an initial occurrence of nonmuscle-invasive disease.…”

Section: Bladder Preservationmentioning

confidence: 99%

“…216 Critics of organ conservation argue that bladder cancer causes a field change that affects the entire transitional epithelium and exposes patients to multiple tumors arising in both space and time. 216 Zietman et al, however, looked at 121 patients who had a complete response with trimodality therapy and found that the majority of these patients retained their bladders free from relapse; of the 25% who experienced a nonmuscle-invasive relapse, the irradiated bladders tolerated TURBT and intravesical therapies well, with complete response rates comparable to patients with an initial occurrence of nonmuscle-invasive disease. The main disadvantages of bladder-sparing strategies are the dependence on TURBTs before and after treatment, the need for lifelong surveillance, the risk of radiation and chemotherapy toxicities, and the potential need for salvage cystectomy after unsuccessful treatment.…”

Section: Bladder Preservationmentioning

confidence: 99%

Bladder Cancer in 2010: How Far have We Come?

Jacobs¹,

Lee

Montie

2010

CA: A Cancer Journal for Clinicians

298

275

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Bladder cancer is the fourth most common cancer and ranks eighth as a cause of death from cancer among men in the United States. Although guidelines assist in treatment, the art of managing bladder cancer, such as the decision to use neoadjuvant chemotherapy and the timing of cystectomy, is still variable. Bladder cancer has a propensity to recur, and with recurrence, a significant number of cases progress, which makes the early detection of high-risk patients imperative. Advances in detection, surveillance, and treatment of bladder cancer are reviewed in this article.

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“…Therefore, higher doses and longer-course regimens are often used with curative intent. Similarly to primary treatment situations, salvage radiotherapy would ideally be supplemented with concurrent chemotherapy (5,8,9). However, the addition of chemotherapy significantly increases treatment toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Those unable to withstand radical surgery are referred for radiotherapy (7). In the case of primary organ-preserving treatment, radiotherapy was shown to be more effective with the addition of concurrent radiosensitizing chemotherapy (5,8,9). In the case of recurrent bladder cancer, patients are often older and less resilient than at the time of their primary treatment and may be unable to tolerate the addition of chemotherapy.…”

mentioning

confidence: 99%

Concurrent Chemotherapy Improves the Overall Survival of Patients Irradiated for Locally Recurrent Bladder Cancer

Rades

Manig

Schild

2017

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Selective bladder conservation using transurethral resection, chemotherapy, and radiation: management and consequences of Ta, T1, and Tis recurrence within the retained bladder

Cited by 131 publications

References 12 publications

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

Bladder Cancer in 2010: How Far have We Come?

Concurrent Chemotherapy Improves the Overall Survival of Patients Irradiated for Locally Recurrent Bladder Cancer

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