The value of clinical prognostic factors for survival in patients with invasive urinary bladder cancer

Abstract

The aim of the study was to evaluate the value of clinical prognostic factors for survival of patients with invasive urinary bladder cancer treated with radical cystectomy, chemotherapy, and radiotherapy. Material and methods. A total of 115 patients with invasive urinary bladder cancer were analyzed. Twenty-three patients with invasive urinary bladder cancer (pT2–T4) were treated according to the protocol of a prospective clinical study. In all the cases, transurethral resection was followed by radiation and chemotherapy. A total dose of 54–60 Gy of radiotherapy was delivered by daily fractions of 1.8–2.0 Gy each. Simultaneous chemotherapy was started on the same day as radiotherapy; gemcitabine at a dose of 175–300 mg/m2 was delivered once a week intravenously for 6 weeks. Individual patient data was analyzed in a retrospective part of the study. Radical cystectomy was performed to 46 patients with invasive urinary bladder cancer, and radiotherapy was delivered to 46 patients. Inclusion criteria for patients into a prospective or retrospective trial were equal. We evaluated a prognostic value of various clinical factors for patients treated with radical cystectomy, chemoradiation with gemcitabine, and radiation alone. Results. The 3-year overall survival in the cystectomy group was 51.1%, in the chemoradiation group 38.0%, and in the radiotherapy group 26.9% (P=0.001). In univariate analysis in the chemoradiation group, completion of treatment according to the protocol showed a significant influence on overall survival (P=0.03). In the radiation group, completion of treatment according to the protocol showed a significant influence on overall survival too (P=0.01). In the radical cystectomy group, an important factor was a complete or incomplete TUR (P=0.02). Multivariate analysis showed a significance of hydronephrosis (P=0.03) and T stage (P=0.04) in the radiation therapy group. Comorbidity was found to be an independent prognostic factors in the chemoradiation group (P=0.02). Conclusions. The best 3-year overall survival was in the radical cystectomy group. Chemoradiation with gemcitabine could be offered as an alternative to patients refusing cystectomy. Better overall survival in the chemoradiation group was for patients without comorbidities and when treatment protocol was completed.

Efficacy and safety of systemic chemotherapy and intra-arterial chemotherapy with/without radiotherapy for bladder preservation or as neo-adjuvant therapy in patients with muscle-invasive bladder cancer: A single-centre study of 163 patients

“…A similar opinion was suggested by another study in which a reduced chemoradiotherapy dose was found to be a significant predictor of reduced survival in patients with MIBC. 8 Urinary disorders were more characteristic of the IAC þ R group than of the other groups. Given the fact that the frequency of this symptom was remarkably higher in the IAC þ R group than in the IAC group, the addition of radiotherapy to IAC is thought to be associated partly with the occurrence of these urological symptoms.…”

“…6,14,15 Moreover, non-CDDP-based regimens have often been used for SC. 8,16,17 In addition to SC, the intraarterial administration of chemotherapeutic agents 6,14,18 or both systemic and intra-arterial administration 21 have also been reported. Regarding the radiotherapy irradiation range, several patterns have been reported, including the bladder only, 18 bladder plus surrounding tissues, 10,16 and bladder plus pelvis 7,12,14,17,19 The irradiation intensity also varies widely, with total doses to the pelvis of <40 Gy, 17,18 54e60 Gy, 8 >60 Gy, 7,9,12e16 and 40 Gy and an additional 10e20 Gy to the bladder in cases with massive tumours.…”

“…19 Furthermore, patient selection was divided into the following patterns: patients with T2 and T3 6,9 or T2e4 disease 7,8,13e15 and those with N0 7,9,13,14 or N1 disease. 8,12 In reality, these multimodal therapies yielded a wide range of CR achievement rates from 39.3% to 90.3%. 7e19 Similarly, the 3-year overall survival rates associated with these bladder preservation therapies were reported to range from 47% to 83%.…”

“…6 Meanwhile, combined SC and radiotherapy is more effective against primary tumours than is SC or radiotherapy alone. 7,8 However, little information is available regarding the superiority of and adverse events associated with IAC and radiotherapy (IAC þ R) versus SC or IAC monotherapy.…”

Efficacy and safety of late‐course hypofractionated radiation therapy for muscle‐invasive bladder carcinoma after bladder‐conserving surgery

“…The radiotherapy with conventional fractionated dose did not provide benefits to patients with a functioning bladder after transurethral resection. Asadauskiene treated invasive bladder cancer with conventional fractionated radiation scheme . The 3‐year overall survival was 51.1% in the cystectomy group, and only 38.0% in the chemoradiation group ( P = 0.001).…”