Selective Bladder Preservation by Combination Treatment of Invasive Bladder Cancer

Kaufman, Donald S.; Shipley, William U.; Griffin, Pamela P.; Heney, Niall M.; Althausen, Alex F.; Efird, Jimmy T.

doi:10.1056/nejm199311043291903

Cited by 223 publications

(82 citation statements)

References 18 publications

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“…Modern selective bladder preservation with trimodality therapy, consisting of maximal transurethral resection of the bladder tumor (TURBT), radiation therapy (RT), and chemotherapy, can achieve complete response rates of 60% to 80%, 5-year survival rates of 50% to 60%, and survival rates with an intact bladder of 40% to 45%. [4][5][6][7][8][9][10][11] Although no randomized comparisons between cystectomy and trimodality therapy exist, long-term data confirm that overall and disease-specific survival rates for patients in bladder-sparing protocols with salvage cystectomy, if necessary, are comparable to outcomes reported in series using primary cystectomy for patients with clinically staged muscle-invading bladder cancer who are cystectomy candidates. 1,5,8,[12][13][14] Successful bladder preservation only has merit if the preserved bladder functions at a level acceptable to the patient.…”

Section: Introductionmentioning

confidence: 99%

Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, 99-06

Efstathiou

Bae

Shipley

et al. 2009

JCO

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208

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A B S T R A C T PurposeIn selected patients with muscle-invasive bladder cancer, combined-modality therapy (transurethral resection bladder tumor [TURBT], radiation therapy, chemotherapy) with salvage cystectomy, if necessary, can achieve survival rates similar to radical cystectomy. We investigated late pelvic toxicity after chemoradiotherapy for patients treated on prospective protocols. Patients and MethodsBetween 1990 and 2002, 285 eligible patients enrolled on four prospective protocols (Radiation Therapy Oncology Group [RTOG] 8903, 9506, 9706, 9906) and 157 underwent combined-modality therapy, surviving Ն 2 years from start of treatment with their bladder intact. Rates of late genitourinary (GU) and GI toxicity were assessed using the RTOG Late Radiation Morbidity Schema, with worst toxicity grade (scale 0 to 5) occurring Ն 180 days after start of consolidation therapy reported for each patient. Persistence of toxicity was defined as grade 3ϩ toxicity not decreasing by at least one grade. Logistic and Cox regression analyses were performed to evaluate relationship between clinical characteristics, frequency, and time to late grade 3ϩ pelvic toxicity. Covariates included age, sex, stage, presence of carcinoma in situ, completeness of TURBT, and protocol. ResultsMedian follow-up was 5.4 years (range, 2.0 to 13.2 years). Seven percent of patients experienced late grade 3ϩ pelvic toxicity: 5.7% GU and 1.9% GI. In only one of nine patients did a grade 3ϩ GU toxicity persist. Notably there were no late grade 4 toxicities and no treatment-related deaths. None of the clinical variables studied predicted for late grade 3ϩ pelvic toxicity. ConclusionRates of significant late pelvic toxicity for patients completing combined-modality therapy for invasive bladder cancer and retaining their native bladder are low.

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Section: Introductionmentioning

confidence: 99%

Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, 99-06

Efstathiou

Bae

Shipley

et al. 2009

JCO

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208

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“…[1][2][3][4][5][6][7][8][9] These series report a median complete response (CR) rate of 70% (range, 56 -87%) after transurethral resection of the bladder tumor (TURB) and radiochemotherapy (RCT). The 5-year overall survival rates are comparable to the rates reported in surgical series using immediate radical cystectomy in patients with the same features.…”

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confidence: 99%

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

Danesi

Arcangeli²,

et al. 2004

Cancer

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BACKGROUNDOrgan preservation has been investigated in patients with muscle‐invasive bladder carcinoma over the past decades as an alternative to radical cystectomy. The majority of studies reported that trimodal schedules, including transurethral resection of bladder tumor (TURB), radiotherapy (RT), and chemotherapy, are a feasible and safe organ‐sparing approach without deferring the survival probability. However, to the authors' knowledge the best combination of RT and chemotherapy has yet to be well defined. The current study evaluated the long‐term results of a schedule of concurrent cisplatin and 5‐fluorouracil (5‐FU) administered as protracted intravenous infusions (PVI) during hyperfractionated radiotherapy (HFRT) with organ‐sparing intent in patients with infiltrating transitional cell carcinoma of the bladder (TCCB).METHODSSeventy‐seven patients with a classification of T2–T4aN0M0 TCCB were enrolled in the current study. After a complete TURB and bladder mapping, 42 of 77 patients underwent 2 cycles of induction chemotherapy. All 77 patients underwent HFRT and a schedule of cisplatin (4–6 mg/m2 per day) and 5‐FU (180–220 mg/m2 per day) as concomitant PVI (radiochemotherapy [RCT]). Six to 8 weeks after RCT, patient response was evaluated by computed tomography scan, urine cytology, and TURB. Patients who achieved a complete response (CR) were followed at regular intervals. For patients with residual or recurrent invasive tumor, salvage cystectomy was recommended.RESULTSSeventy‐two patients were evaluable for response: 65 achieved a CR (90.3%) and 7 (9.7%) achieved a partial response. No significant difference was observed for the different prognostic factors with the exception of stage of disease (T2 [95.7%] vs. T3–T4a [80.0%]; P = 0.04). The observed toxicity, mainly hematologic, was higher among the patients who received induction chemotherapy compared with the patients who did not receive induction chemotherapy, even though the difference was not statistically significant. After a median follow‐up of 82.2 months (range, 30–138 months), 44 of 65 (57.1%) patients who achieved a CR were alive. Of these 44 patients, 33 had tumor‐free bladders. The 5‐year overall, bladder‐intact, tumor‐specific, disease‐free, and cystectomy‐free survival rates for all 77 patients were 58.5%, 46.6%, 75.0%, 53.5%, and 76.1%, respectively. No associations were observed in overall and tumor‐specific survival with different prognostic factors.CONCLUSIONSCombined treatment appeared to provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients who refuse or are unsuitable for surgery. Cancer 2004. © 2004 American Cancer Society.

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“…This highlights the difficult and relatively uninformed choice patients have to make: undergo primary surgery, or have radiotherapy in the hope of preserving bladder function, but still actually run a 30–50% lifetime chance of needing a cystectomy. The same may also be true of newer organ–sparing combination treatments which appear to provide acceptable survival rates which may be equivalent to primary cystectomy [1, 2, 18, 19], though the long–term organ preservation rates and QOL for these have yet to be established.…”

Section: Discussionmentioning

confidence: 99%

Long–Term Risk of Salvage Cystectomy after Radiotherapy for Muscle–Invasive Bladder Cancer

et al. 2000

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Selective Bladder Preservation by Combination Treatment of Invasive Bladder Cancer

Abstract: Conservative combination treatment may be an acceptable alternative to immediate cystectomy in selected patients with bladder cancer, although a randomized clinical trial that included a group for simultaneous comparison would be required to produce definitive results.

Cited by 223 publications

References 18 publications

Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, 99-06

Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, 99-06

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

Long–Term Risk of Salvage Cystectomy after Radiotherapy for Muscle–Invasive Bladder Cancer

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Selective Bladder Preservation by Combination Treatment of Invasive Bladder Cancer

Abstract: Conservative combination treatment may be an acceptable alternative to immediate cystectomy in selected patients with bladder cancer, although a randomized clinical trial that included a group for simultaneous comparison would be required to produce definitive results.

Cited by 223 publications

References 18 publications

Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, 99-06

Late Pelvic Toxicity After Bladder-Sparing Therapy in Patients With Invasive Bladder Cancer: RTOG 89-03, 95-06, 97-06, 99-06

Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy

Long&ndash;Term Risk of Salvage Cystectomy after Radiotherapy for Muscle&ndash;Invasive Bladder Cancer

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Long–Term Risk of Salvage Cystectomy after Radiotherapy for Muscle–Invasive Bladder Cancer