Utilization and Outcomes of Radical Cystectomy for High-grade Non–muscle-invasive Bladder Cancer in Elderly Patients

Parker, William P.; Smelser, Woodson; Lee, Eugene K.; Habermann, Elizabeth B.; Thapa, Prabin; Zaid, Harras B.; Frank, Igor; Griebling, Tomas L.; Tollefson, Matthew K.; Thompson, R. Houston; Holzbeierlein, Jeffrey M.; Karnes, R. Jeffrey; Boorjian, Stephen A.

doi:10.1016/j.clgc.2017.07.011

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…The golden standard for stage T2-T4a, a radical cystectomy (RC) with neoadjuvant chemotherapy (NAC) [4] is associated with 90-days complication and mortality rates up to 58% and 7% [5,6]. Patients with advanced age (representing the majority of the MIBC population) are therefore frequently medically unfit or unwilling to undergo RC, causing a risk of undertreatment [7]. This key issue in MIBC management highlights the need for bladder-sparing treatments.…”

Section: Introductionmentioning

confidence: 99%

DPPG₂-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

Brummelhuis

Simons

Lindner

et al. 2021

International Journal of Hyperthermia

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Purpose: Recommended treatments for muscle-invasive bladder cancer (MIBC) come with considerable morbidity. Hyperthermia (HT) triggered drug release from phosphatidylglycerol-based thermosensitive liposomes (DPPG 2 -TSL) might prevent surgical bladder removal and toxicity from systemic chemotherapy. We aimed to assess the efficacy of DPPG 2 -TSL with HT in a syngeneic orthotopic rat urothelial carcinoma model. Methods: A total of 191 female Fischer F344 rats were used. Bladder tumors were initiated by inoculation of AY-27 cells and tumor-bearing rats were selected with cystoscopy and semi-randomized over treatment groups. On days 5 and 8, animals were treated with DOX in different treatment modalities: intravenous (iv) DPPG 2 -TSL-DOX with HT, iv free DOX without HT, intravesical DOX without HT, intravesical DOX with HT or no treatment (control group), respectively. Animals were euthanized on day 14 and complete tumor response was assessed by histopathological evaluation. Results: Iv DPPG 2 -TSL-DOX þ HT resulted in a favorable rate of animals with complete tumor response (70%), compared to iv free DOX (18%, p ¼ .02), no treatment (0%, p ¼ .001), and intravesical DOX with (43%, p ¼ .35) or without HT (50%, p ¼ .41). All rats receiving intravesical DOX with HT and 24% of rats treated with DPPG 2 -TSL-DOX containing the same DOX dose with HT had to be euthanized before day 14 because of substantial bodyweight loss, which was associated with dilated ureters urine retention in a few rats. Conclusion: Treatment with DPPG 2 -TSL-DOX combined with intravesical HT outperformed systemic and intravesical DOX in vivo. There might be a role for DPPG 2-TSL encapsulating chemotherapeutics in the treatment of MIBC in the future.

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Section: Introductionmentioning

confidence: 99%

DPPG₂-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

Brummelhuis

Simons

Lindner

et al. 2021

International Journal of Hyperthermia

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“…Median operative time and intraoperative blood loss were consistent with that observed for RC performed for MIBC [ 21 ]. However, with regard to postoperative outcomes, the risk of early postoperative complications after eRC has been previously reported in three retrospective studies [ 13 , 14 , 15 ]. Interestingly, ≥ grade 3 complications occurred in 6% to 20% of the included patients [ 14 ], with no significant difference the between patients treated with upfront or delayed eRC in the study by Ali-El-Dein et al [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, some reports suggested a survival benefit with the use of upfront [ 5 , 6 , 7 , 8 ], or delayed eRC [ 10 , 11 ], while others found no difference between either of them [ 12 , 13 ]. In addition, very few data have been published on the perioperative results of upfront or delayed eRC [ 13 , 14 , 15 ]. Against this backdrop, our aim was to evaluate eRC by comparing perioperative and oncological outcomes obtained after upfront or delayed procedures for HR-NMIBC.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer

Diamant

Roumiguié

Ingels

et al. 2022

Cancers

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Purpose: The purpose of this study is to compare perioperative and oncological outcomes of upfront vs. delayed early radical cystectomy (eRC) for high-risk non-muscle-invasive bladder cancer (HR-NMIBC). Methods: All consecutive HR-NMIBC patients who underwent eRC between 2001 and 2020 were retrospectively included and divided into upfront and delayed groups, according to the receipt or not of BCG. Perioperative outcomes were evaluated and the impact of upfront vs. delayed eRC on pathological upstaging, defined as ≥pT2N0 disease at final pathology, was assessed using multivariable logistic regression. Recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) were compared between upfront and delayed eRC groups using inverse probability of treatment weighting (IPTW)-adjusted Cox model. Results: Overall, 184 patients received either upfront (n = 87; 47%) or delayed (n = 97; 53%) eRC. No difference was observed in perioperative outcomes between the two treatment groups (all p > 0.05). Pathological upstaging occurred in 55 (30%) patients and upfront eRC was an independent predictor (HR = 2.65; 95% CI = (1.23–5.67); p = 0.012). In the IPTW-adjusted Cox analysis, there was no significant difference between upfront and delayed eRC in terms of RFS (HR = 1.31; 95% CI = (0.72–2.39); p = 0.38), CSS (HR = 1.09; 95% CI = (0.51–2.34); p = 0.82) and OS (HR = 1.19; 95% CI = (0.62–2.78); p = 0.60). Conclusion: our results suggest similar perioperative outcomes between upfront and delayed eRC, with an increased risk of upstaging after upfront eRC that did impact survival, as compared to delayed eRC.

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“…In addition, the physical and social quality of life of patients after radical cystectomy is significantly reduced. Also, do not forget that bladder cancer is more common in older people, most of whom have poor comorbid status due to concomitant pathology [12].…”

Section: Introductionmentioning

confidence: 99%

Prospects for the use of the method of intravesical hyperthermic chemotherapy in the treatment of patients with non-muscle invasive bladder cancer

Chystiakov

2021

SR:MS

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The aim: to compare disease-free survival time (DFS) in high-risk non-muscle-invasive bladder cancer patients treated with adjuvant hyperthermic intravesical chemotherapy and standard BCG therapy. Materials and methods: patients were divided into 2 groups. Group 1 (control) included patients who received adjuvant therapy after TURB with BCG vaccine (BCG therapy group; n=50), group 2 (study group) included patients (HIVEC® therapy group; n=46 ), who received adjuvant intravesical chemotherapy using a Combat BRS HIVEC® device for local hyperthermia. Results: median follow-up was 23 months (range 4 - 36). Tumor recurrence was reported in 19 patients receiving intravesical BCG therapy and in 8 patients receiving intravesical hyperthermic chemotherapy. The incidence of DFS in patients receiving chemohyperthermy was statistically higher than in patients receiving BCG therapy (log-rank test result: p=0.029). Conclusions: The method of hyperthermic intravesical chemotherapy significantly increased the 2-year disease-free survival rate - 82.6 % versus 62 % BCG therapy group (p=0.025). Its use in the future will allow increasing the frequency of organ-preserving treatment of patients with primary and recurrent muscular-non-invasive bladder tumors

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Utilization and Outcomes of Radical Cystectomy for High-grade Non–muscle-invasive Bladder Cancer in Elderly Patients

Cited by 13 publications

References 20 publications

DPPG₂-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

DPPG₂-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer

Prospects for the use of the method of intravesical hyperthermic chemotherapy in the treatment of patients with non-muscle invasive bladder cancer

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Utilization and Outcomes of Radical Cystectomy for High-grade Non–muscle-invasive Bladder Cancer in Elderly Patients

Cited by 13 publications

References 20 publications

DPPG2-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

DPPG2-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer

Prospects for the use of the method of intravesical hyperthermic chemotherapy in the treatment of patients with non-muscle invasive bladder cancer

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DPPG₂-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo

DPPG₂-based thermosensitive liposomes as drug delivery system for effective muscle-invasive bladder cancer treatment in vivo