The Efficacy of Trimodal Chemoradiotherapy with Cisplatin as a Bladder-Preserving Strategy for the Treatment of Muscle-Invasive Bladder Cancer

Abstract

Introduction: Open radical cystectomy (ORC) is currently the standard treatment for muscle-invasive bladder cancer (MIBC) without metastasis, while many patients with MIBC are not always appropriate candidates due to multiple comorbidities. To evaluate the bladder-preservation strategy, we compared the results with those obtained by ORC. Patients and Methods: We retrospectively analyzed the data of 50 patients with MIBC treated by trimodal chemoradiotherapy with cisplatin (CDDP-radiation [CDDP-R]). Transurethral resection of the bladder tumor (TURBT) was performed before treatment to confirm pathological stage ≥T2. Extensive TURBT was performed after chemoradiotherapy to evaluate the pathological response to treatment. We compared the survival outcomes of our CDDP-R with those of ORC (retrospective cohort, n = 205) by propensity score matching analysis. Results: The 2- and 5-year progression-free survival, bladder-intact survival, cancer-specific survival, and overall survival (OS) rates after treatment were 70.8 and 63.9%, 64.0 and 49.8%, 86.7 and 71.8%, and 84.3 and 64.8%, respectively. The 2- and 5-year OS rates after CDDP-R were 90.5 and 74.3%, respectively, and those after ORC were 71.8 and 59.9%, respectively, indicating a significant survival advantage conferred by CDDP-R over ORC (p < 0.05, HR 0.45, 95% CI 0.21-0.94). Conclusions: In selected patients, CDDP-R for MIBC may provide comparative oncological outcomes as ORC.

Long-Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High-Risk Bladder Cancer (Ta, Tis, T1, T2)

“…Our analysis intends to contribute to the discussion of when bladder‐preservation therapy in high‐risk bladder cancer is possible. Cystectomy, with or without neoadjuvant therapy, as well as various bladder‐preservation therapies are proven effective for the treatment of bladder cancer . Nevertheless, a direct comparison between bladder‐preservation modalities and radical cystectomy is difficult because of the lack of sufficiently sized randomized studies.…”

Systematic review and meta-analysis on trimodal therapy versus radical cystectomy for muscle-invasive bladder cancer: Does the current quality of evidence justify definitive conclusions?

“…All studies were of retrospective nature and recruited patients in the interval between 1995 and 2014 with median follow-up times ranging from 13 months to 54 months. Five eligible studies were single-center studies (Israel: 1 [19], Japan: 2 [20, 21], South Korea: 1 [22], Canada: 1 [23]) while 7 studies were population-based and relied on two partially overlapping United States-based registries (Surveillance, Epidemiology, and End Results [SEER]-Medicare database: 2 [24, 25], National Cancer Database [NCDB]: 5 [26–30]) and hence provided a higher number of patients compared to the single-center studies (N single-center : 413, N SEER-Medicare (max) : 1843, N NCDB (max) : 24169). The majority of the identified studies included cT2-T4/cN0/cM0 patients without any age restrictions.…”

“…The analytic strategies used in the individual studies and the corresponding effect estimates are presented in Table 2 . The effect estimates and standard errors of the 3 studies that used Kaplan-Meier analysis were derived graphically [19, 21, 26].…”

A Novel DNA Methylation Signature as an Independent Prognostic Factor in Muscle-Invasive Bladder Cancer

“…Bladder-preservation therapy for MIBC patients has shown benefit for MIBC patients in maintaining normal bladder function ( 35 – 37 ). Currently, many MIBC patients are candidates for bladder preservation with trimodal therapy (maximal TURBT, chemotherapy, and radiotherapy) ( 38 , 39 ). Our RS may potentially help to select targeted patients for preservation therapy in clinical decision making, such as candidates with high RS should avoid bladder-preservation therapy but radical cystectomy.…”