The Impact of Lymphadenectomy and Lymph Node Metastasis on the Outcomes of Radical Cystectomy for Bladder Cancer

Karl, Alexander; Carroll, Peter R.; Gschwend, Jürgen E.; Knüchel, Ruth; Montorsi, Francesco; Stief, Christian G.; Studer, Urs E.

doi:10.1016/j.eururo.2009.01.004

Cited by 180 publications

(116 citation statements)

References 52 publications

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“…12 Recent investigations suggest a therapeutic significance concerning PLND at RC for MIBC patients, even if microscopic evidence of lymph node metastasis is absent. 54 Early series of trimodality therapy that included pelvic lymph nodes in radiation portals of induction CRT yielded pelvic failure rates of 8.4-13%, 15,47,49 which were lower than the incidence of pelvic lymph node metastasis in the upfront RC series. In our single-institutional comparative study, the incidence of pelvic lymph node metastasis was 19% for MIBC patients undergoing upfront RC, but just 8% for those undergoing induction CRT before cystectomy.…”

Section: Pelvic Recurrencementioning

confidence: 99%

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Koga

Kihara

2012

Int J of Urology

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Abbreviations & Acronyms BIS = bladder-intact survival CIS = carcinoma in situ CR = complete response CRT = chemoradiotherapy CSS = cancer-specific survival FU = fluorouracil GasLESS = gasless laparoendoscopic single-port surgery GC = gemcitabine, cisplatin HD = hemodialysis IAC = intra-arterial chemotherapy IMRT = intensity-modulated radiation therapy LCRT = low-dose chemoradiotherapy MCV = methotrexate, cisplatin and vinblastine MIBC = muscle-invasive bladder cancer MRI = magnetic resonance imaging MVAC = methotrexate, vinblastine, adriamycin and cisplatin NA = not available NFkB = nuclear factor kB NMIBC = non-muscle-invasive bladder cancer OS = overall survival PC = partial cystectomy PLND = pelvic lymph node dissection QoL = quality of life RC = radical cystectomy RTOC = Radiation Therapy Oncology Group SPARE = Selective bladder Preservation Against Radical Excision TMDU = Tokyo Medical and Dental University TURBT = transurethral resection of bladder tumors Abstract: Radical cystectomy plus urinary diversion, the reference standard treatment for muscle-invasive bladder cancer, associates with high complication rates and compromises quality of life as a result of long-term effects on urinary, gastrointestinal and sexual function, and changes in body image. As a society ages, the number of elderly patients unfit for radical cystectomy as a result of comorbidity will increase, and thus the demand for bladder-sparing approaches for muscle-invasive bladder cancer will also inevitably increase. Trimodality bladder-sparing approaches consisting of transurethral resection, chemotherapy and radiotherapy (S55-65 Gy) yield overall survival rates comparable with those of radical cystectomy series (50-70% at 5 years), while preserving the native bladder in 40-60% of muscle-invasive bladder cancer patients, contributing to an improvement in quality of life for such patients. Limitations of the trimodality therapy include (i) muscle-invasive bladder cancer recurrence in the preserved bladder, which most often arises in the original muscle-invasive bladder cancer site; (ii) potential lack of curative intervention for regional lymph nodes; and (iii) increased morbidity in the event of salvage radical cystectomy for remaining or recurrent disease as a result of high-dose pelvic irradiation. Consolidative partial cystectomy with pelvic lymph node dissection followed by induction chemoradiotherapy at lower dose (e.g. 40 Gy) is a rational strategy for overcoming such limitations by strengthening locoregional control and reducing radiation dosage. Molecular profiling of the tumor and functional imaging might play important roles in optimal patient selection for bladder preservation. Refinement of radiation techniques, intensified concurrent or adjuvant chemotherapy, and novel sensitizers, including molecular targeting agent, are also expected to improve outcomes and consequently provide more muscle-invasive bladder cancer patients with favorable quality of life.

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Section: Pelvic Recurrencementioning

confidence: 99%

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Koga

Kihara

2012

Int J of Urology

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“…As already referred, controversy exists regarding the optimal extent of lymphadenectomy and the number of lymph nodes to be retrieved at radical cystectomy. An extended pelvic lymph node dissection (encompassing the external iliac vessels, the obturator fossa, the lateral and medial aspects of the internal iliac vessels, and at least the distal half of the common iliac vessels together with its bifurcation) has been suggested as potentially curative in patients with metastasis or micrometastasis to a few nodes (Karl et al, 2009;AbolEnein et al, 2011). Wright and colleagues observed that an increased number of lymph nodes removed at the time of radical cystectomy associates with improved survival in patients with lymph node-positive bladder cancer (Wright et al, 2008).…”

Section: Angiogenesis Lymphangiogenesis and Lymphovascular Invasion mentioning

confidence: 99%

Angiogenesis, Lymphangiogenesis and Lymphovascular Invasion: Prognostic Impact for Bladder Cancer Patients

Afonso¹,

Santos²,

Longatto‐Filho³

2012

Bladder Cancer - From Basic Science to Robotic Surgery

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“…Radical cystectomy series report that approximately 25% of patients initially staged T1-T4 N0 M0 who undergo lymphadenectomy have lymph node metastases; and the absolute number of positive nodes removed affects survival 9 48 . It has been stated that, as a guideline, removal of >20 nodes per patient should be the aim 48 . Others have reported an improved cancer-specific survival rate of 65% when ≥ 16 nodes were retrieved compared to 51% when < 16 nodes were retrieved 49 .…”

Section: Lymphadenectomymentioning

confidence: 99%

Robot-Assisted Radical Cystectomy as a Treatment Modality for Patients with Muscle-Invasive Bladder Cancer

Schumacher¹

2012

Bladder Cancer - From Basic Science to Robotic Surgery

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The Impact of Lymphadenectomy and Lymph Node Metastasis on the Outcomes of Radical Cystectomy for Bladder Cancer

Cited by 180 publications

References 52 publications

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Angiogenesis, Lymphangiogenesis and Lymphovascular Invasion: Prognostic Impact for Bladder Cancer Patients

Robot-Assisted Radical Cystectomy as a Treatment Modality for Patients with Muscle-Invasive Bladder Cancer

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