Incidence, Clinicopathological Risk Factors, Management and Outcomes of Nonmuscle Invasive Recurrence after Complete Response to Trimodality Therapy for Muscle Invasive Bladder Cancer

2018 ◽  
Vol 199 (2) ◽  
pp. 407-415 ◽  
Author(s):  
Alejandro Sanchez ◽  
Matthew F. Wszolek ◽  
Andrzej Niemierko ◽  
Rebecca H. Clayman ◽  
Michael Drumm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Complete Response ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Trimodality Therapy ◽  
Muscle Invasive

Epidemiology and Risk Factors in Muscle Invasive Bladder Cancer

2021 ◽  
pp. 7-12
Author(s):  
Sanchia S. Goonewardene ◽  
Karen Ventii ◽  
Amit Bahl ◽  
Raj Persad ◽  
Hanif Motiwala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Association of treatment facility case volume with survival in patients undergoing radiotherapy/chemoradiotherapy for muscle-invasive bladder cancer: An analysis of the National Cancer Database.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 295-295
Author(s):  
Amishi Bajaj ◽  
Alec Block ◽  
Brendan Martin ◽  
Mark Korpics ◽  
Courtney Hentz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Univariate Analysis ◽  
High Volume ◽  
Invasive Bladder Cancer ◽  
National Cancer Database ◽  
Treatment Facility ◽  
Case Volume ◽  
Muscle Invasive Bladder Cancer ◽  
Trimodality Therapy ◽  
Muscle Invasive

295 Background: Excellent outcomes with bladder-preserving trimodality therapy have been demonstrated at centers with expertise and high-volume. Some argue that these results may not be replicated at other centers with lower case volumes. We analyzed the National Cancer Database to determine if treatment at a high-volume facility is associated with improved overall survival (OS) for patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) for non-metastatic muscle-invasive bladder cancer (MIBC). Methods: Patients with cT2-4 N0-3 M0 transitional cell MIBC treated with RT or CRT were selected. The case volume variable was derived by calculating a count of patient records by each facility using the entire database of 439,188 patients. Multivariate analysis (MVA) was performed using the Cox proportional hazards model, which was used to assess the association of case volume with OS while controlling for clinicodemographic and treatment factors associated with OS on univariate analysis, including clustering of patients within their treatment facility type. Results: 872 patients treated with radiotherapy from 2008-2012 at 452 unique facilities were identified. 502 (58%) patients received RT, and 370 (42%) patients received CRT. The median case volume at each unique facility was 376 cases with an interquartile range of 235 – 579 cases. In the entire radiotherapy cohort, MVA controlling for patient case load, age, sex, education, T Stage, N Stage, cumulative radiotherapy dose, Charlson-Deyo comorbidity score, and geographic location, demonstrated that treatment at a facility with a higher case volume was associated with improved OS. For every 250 patient increase in facility case volume, the hazard of death at any given time for patients receiving radiotherapy decreased by 7% (HR = 0.93, 95% CI: 0.87 – 0.98, p = .01). Conclusions: To the authors’ knowledge, this is the first analysis demonstrating an association between treatment facility case volume and OS in the treatment of MIBC patients with RT or CRT. Consideration should be given to referring patients to high volume facilities for treatment of MIBC.

scholarly journals The Effect of Tri-Modality Therapy with Bladder Preservation for Selective Muscle-Invasive Bladder Cancer

2021 ◽  
Vol 20 ◽  
pp. 153303382110623
Author(s):  
Zhang Zhiyu ◽  
Zhou Qi ◽  
Song Zhen ◽  
Ouyang Jun ◽  
Zhang Jianglei
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Linear Regression Analysis ◽  
Univariate Analysis ◽  
Tnm Staging ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Significant Difference ◽  
Muscle Invasive

Objectives: To compare the efficacy of complete transurethral resection of bladder tumor combined with postoperative chemoradiotherapy and radical cystectomy (RC) in the treatment of muscle-invasive bladder cancer (MIBC). Methods: This is a single-center, retrospective study. Clinical data of 125 patients with MIBC admitted to the First Affiliated Hospital of Soochow University from December 2012 to December 2015 were retrospectively analyzed, in which 79 patients (tri-modality therapy [TMT] group) received TMT bladder-sparing treatment, and 41 patients (RC group) received RC. The differences of probabilities for 1-year, 2-year, 5-year, and comprehensive overall survival (OS), progress-free survival (PFS) between 2 groups were calculated using Kaplan–Meier product limited estimates. Univariate and multivariate analyses were performed to detect potential risk factors for OS and PFS. Results: There was no statistical difference between the TMT group and RC group in the 1-year, 2-year, 5-year, comprehensive OS rate, and PFS rate. And survival analysis found no significant difference in OS and PFS between the 2 groups. Univariate analysis showed that age, TNM staging, and prognostic nutritional index (PNI) were associated with OS, while PNI was connected to tumor recurrence. Multiple linear regression analysis indicated that TNM staging and PNI were independent risk factors for OS. Conclusions: TMT can be used as an alternative to RC for MIBC patients under the premise of strict control of indications, rigorous postoperative follow-up, and timely salvage cystectomy. PNI was negatively correlated with OS and PFS, while TNM staging was positively correlated with OS.

Neoadjuvant accelerated MVAC (AMVAC) in patients with muscle invasive bladder cancer: Results of a multicenter phase II study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4526-4526 ◽  
Author(s):  
Elizabeth R. Plimack ◽  
Jean H. Hoffman-Censits ◽  
Rosalia Viterbo ◽  
Richard Evan Greenberg ◽  
David Chen ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Invasive Disease ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Metastatic Setting ◽  
Grade 3 ◽  
Muscle Invasive ◽  
Intent To Treat

4526 Background: Standard methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) demonstrates a survival benefit in the neoadjuvant setting for patients (pts) with muscle invasive bladder cancer (MIBC). Compared with standard MVAC, AMVAC yielded higher response rates with less toxicity in the metastatic setting. Methods: Pts with MIBC, cT2-T4a, and N0-N1 with CrCl >=50 and adequate hepatic and marrow function were eligible. Pts received 3 cycles of AMVAC (methotrexate 30 mg/m2, vinblastine 3 mg/m2, doxorubicin 30 mg/m2, cisplatin 70mg/m2) on day 1, with pegfilgrastim 6 mg day 2 or 3, every 2 weeks. Pts with CrCl < 60 could receive cisplatin split over 2 days. Radical cystectomy (RC) with lymph node dissection was performed 4-8 weeks after the last dose of chemotherapy. Primary endpoint was pathologic complete response (pCR) rate. Results: Accrual is complete with 44 MIBC pts enrolled at 2 institutions (FCCC, TJU) over a 25 month period. Median age 64 (range 45-83). Three withdrew from study early and are not evaluable for response (2 physician discretion, 1 withdrawal of consent). An additional 8 are currently receiving treatment on study with toxicity and response data pending. Of the 33 evaluable pts for whom final data is available, 30 received all 3 cycles of AMVAC at full dose. Three pts received < 3 cycles due to grade 3 fatigue (1), low platelets (1), and disease progression precluding RC (1). 32/33 pts underwent RC, all within 8 weeks of last chemotherapy. Median time from start of chemotherapy to RC was 9.7 wks (range 4.6-13 wks). 13/33 pts (39.4%, 95% CI, 22.7-56.1%) had a pCR. An additional 3 (9.1%) were downstaged to non muscle invasive disease. For the intent to treat cohort (n=36) 8 pts had grade 3-4 AMVAC related adverse events, the most common being anemia (3), fatigue (3) and neutropenia (2) and overall pCR rate was 36.1%. (95% CI, 20.4-51.8%). All pts will have completed study treatment by April 2012. Final results will be presented. Conclusions: Neoadjuvant AMVAC is well tolerated and preliminary results show a pCR rate similar to that reported for standard 12-week MVAC, suggesting that AMVAC for three cycles (6 weeks) is a safe and efficient alternative.

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