scholarly journals Risk factors for loco-regional recurrence after radical cystectomy of muscle-invasive bladder cancer: A systematic-review and framework for adjuvant radiotherapy

2018 ◽  
Vol 70 ◽  
pp. 88-97 ◽  
Author(s):  
Paul Sargos ◽  
Brian C. Baumann ◽  
Libni Eapen ◽  
John Christodouleas ◽  
Amhit Bahl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Adjuvant Radiotherapy ◽  
Invasive Bladder Cancer ◽  
Regional Recurrence ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

scholarly journals Survival Outcomes of Early versus Deferred Cystectomy for High-Grade Non-Muscle-Invasive Bladder Cancer: A Systematic Review

2020 ◽  
Vol 14 (2) ◽  
pp. 66-73
Author(s):  
Jonathan C. M. Wan
Keyword(s):  
Systematic Review ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Treatment Plan ◽  
Invasive Bladder Cancer ◽  
Survival Outcomes ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Term Survival ◽  
Muscle Invasive

Background: Studies report that survival outcomes in patients with non-muscle-invasive bladder cancer (NMIBC) are worse when cystectomy is delayed. However, no systematic evidence is available. Objective: The aim of this study was to systematically review the literature to compare the long-term survival outcomes of patients with high-grade NMIBC (T1G3, including carcinoma in situ) who have early cystectomy compared to deferred radical cystectomy post-diagnosis. Materials and Methods: A systematic review was carried out by searching MEDLINE and related databases (Google Scholar, National Health Service Evidence) for all relevant studies published from 1946 to present. Additional studies were identified through following the references of relevant papers. Studies were included if they met the following criteria: inclusion of at least 30 patients having high-grade NMIBC, 2 groups treated with either early or deferred cystectomy with a clear temporal cut-off between groups and reported data on survival rate of at least 5 years. Results: Literature was systematically reviewed, and 10 studies were included, totaling 1,516 patients who underwent either primary cystectomy or deferred cystectomy. It was found that patients who underwent early cystectomy show improved 5- to 10-year cancer-specific survival (relative risk = 0.81, p = 0.029) suggesting a significant survival benefit when compared to deferred cystectomy. Conclusions: This study provides systematically gathered evidence showing benefit of early cystectomy. Despite this result, radical cystectomy greatly impairs quality of life and represents overtreatment for a significant minority. This result highlights the importance of a decisive treatment plan to minimize treatment delay.

scholarly journals Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0174978 ◽  
Author(s):  
Mathieu Orré ◽  
Igor Latorzeff ◽  
Aude Fléchon ◽  
Guilhem Roubaud ◽  
Véronique Brouste ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Multicenter Study ◽  
Adjuvant Radiotherapy ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
Retrospective Multicenter Study

Adjuvant radiotherapy use after radical cystectomy in muscle-invasive bladder cancer: A survey of U.S. radiation oncologists.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 369-369
Author(s):  
Abhishek Ashok Solanki ◽  
Brendan Martin ◽  
Mark Korpics ◽  
Christina Small ◽  
Matthew M. Harkenrider ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Logistic Regression ◽  
High Risk ◽  
Radical Cystectomy ◽  
Adjuvant Radiotherapy ◽  
Transitional Cell ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Radiation Oncologists ◽  
Muscle Invasive

369 Background: Historic trials suggested significant toxicity with adjuvant radiotherapy (ART) after radical cystectomy for muscle-invasive bladder cancer (MIBC). However, recent trials have found improved locoregional control and the 2016 NCCN guidelines recommend ART consideration for select patients at high risk of local recurrence. ART practice patterns among U.S. radiation oncologists (ROs) are unknown, and we performed a survey to explore current trends. Methods: We conducted a survey of U.S. ROs regarding the management of patients with cT2-3N0M0 transitional cell MIBC. Responses were reported using descriptive statistics. Chi-square and univariate logistic regression (UVA) of clinical and demographic covariates were conducted, followed by multivariable logistic regression analyses (MVA) to identify factors predicting for ART use. Results: 277 ROs completed our survey. Nearly half (46%) use ART for MIBC. In ART-users, indications for ART include gross residual disease (93%), positive margins (92%), pathologic nodal involvement (64%), pT3 or T4 disease (46%), lymphovascular invasion (16%), and high-grade disease (13%). On UVA, ART use was associated with the number of years in practice (p=.043), pre-cystectomy RO consultation (p=0.004), primarily treating MIBC patients fit for cystectomy (p=0.009), and intensity-modulated radiotherapy (IMRT) use (p=0.009). On MVA, routine pre-cystectomy RO consultation (odds ratio [OR] 1.91, 95% confidence interval [CI]: 1.04-3.51; p=.037) and IMRT use (OR 2.77, 95% CI: 1.48-5.22; p=.002) remained associated with ART use. Conclusions: ART use is controversial in bladder cancer, yet is unexpectedly commonly used among U.S. radiation oncologists treating patients with MIBC after radical cystectomy. NRG GU001 is a randomized trial currently accruing patients with high-risk pathologic findings for observation or ART after cystectomy, and will hopefully clarify the role of ART and help identify patients benefiting from this adjuvant therapy. Whenever possible, patients should be enrolled in this study.

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