High-intensity local treatment of clinical node-positive urothelial carcinoma of the bladder alongside systemic chemotherapy improves overall survival

2021 ◽  
Author(s):  
Akshay Sood ◽  
Jacob Keeley ◽  
Isaac Palma-Zamora ◽  
Giacomo Novara ◽  
Mohamed Elshaikh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Urothelial Carcinoma ◽  
High Intensity ◽  
Systemic Chemotherapy ◽  
Local Treatment ◽  
Node Positive ◽  
Carcinoma Of The Bladder

Efficacy of High-Intensity Local Treatment for Metastatic Urothelial Carcinoma of the Bladder: A Propensity Score–Weighted Analysis From the National Cancer Data Base

2016 ◽  
Vol 34 (29) ◽  
pp. 3529-3536 ◽  
Author(s):  
Thomas Seisen ◽  
Maxine Sun ◽  
Jeffrey J. Leow ◽  
Mark A. Preston ◽  
Alexander P. Cole ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Urothelial Carcinoma ◽  
High Intensity ◽  
Cox Regression ◽  
Local Treatment ◽  
National Cancer Data Base ◽  
Cancer Data ◽  
Kaplan Meier ◽  
Metastatic Urothelial Carcinoma ◽  
Carcinoma Of The Bladder

Purpose Evidence from studies of other malignancies has indicated that aggressive local treatment (LT), even in the presence of metastatic disease, is beneficial. Against a backdrop of stagnant mortality rates for metastatic urothelial carcinoma of the bladder (mUCB) at presentation, we hypothesized that high-intensity LT of primary tumor burden, defined as the receipt of radical cystectomy or ≥ 50 Gy of radiation therapy delivered to the bladder, affects overall survival (OS). Patients and Methods We identified 3,753 patients within the National Cancer Data Base who received multiagent systemic chemotherapy combined with high-intensity versus conservative LT for primary mUCB. Patients who received no LT, transurethral resection of the bladder tumor alone, or < 50 Gy of radiation therapy delivered to the bladder were included in the conservative LT group. Inverse probability of treatment weighting (IPTW) –adjusted Kaplan-Meier curves and Cox regression analyses were used to compare OS of patients who received high-intensity versus conservative LT. Results Overall, 297 (7.91%) and 3,456 (92.09%) patients with mUCB received high-intensity and conservative LT, respectively. IPTW-adjusted Kaplan-Meier curves showed that median OS was significantly longer in the high-intensity LT group than in the conservative LT group (14.92 [interquartile range, 9.82 to 30.72] v 9.95 [interquartile range, 5.29 to 17.08] months, respectively; P < .001). Furthermore, in IPTW-adjusted Cox regression analysis, high-intensity LT was associated with a significant OS benefit (hazard ratio, 0.56; 95% CI, 0.48 to 0.65; P < .001). Conclusion We report an OS benefit for individuals with mUCB treated with high-intensity versus conservative LT. Although the findings are subject to the usual biases related to the observational study design, these preliminary data warrant further consideration in randomized controlled trials, particularly given the poor prognosis associated with mUCB.

Management of elderly patients with urothelial carcinoma of the bladder: guideline concordance and predictors of overall survival

2010 ◽  
Vol 106 (9) ◽  
pp. 1324-1329 ◽  
Author(s):  
Christian Bolenz ◽  
Richard Ho ◽  
Geoffrey R. Nuss ◽  
Nicolas Ortiz ◽  
Ganesh V. Raj ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Urothelial Carcinoma ◽  
Carcinoma Of The Bladder

scholarly journals Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy

2019 ◽  
Author(s):  
Takashige Abe ◽  
Keita Minami ◽  
Toru Harabayashi ◽  
Ataru Sazawa ◽  
Hiroki Chiba ◽  
...  
Keyword(s):  
Overall Survival ◽  
Disease Control ◽  
Urothelial Carcinoma ◽  
Systemic Chemotherapy ◽  
Hazard Ratio ◽  
Prognostic Impact ◽  
Significant Difference ◽  
Metastatic Urothelial Carcinoma ◽  
Consolidative Radiotherapy

Abstract Objective To clarify the prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients treated by systemic chemotherapy. Methods Of the 228 metastatic urothelial carcinoma patients treated with systemic chemotherapy, 97 received radiotherapy mainly to metastatic sites. In patients for whom the purpose of radiotherapy was not specified, more than 50 Gy irradiation was considered to be for disease consolidation for survival analysis, while less than 50 Gy was categorized as palliation. According to the Kaplan–Meier method, we analysed overall survival from the initiation of treatment for metastatic urothelial carcinoma until death or the last follow-up, using the log-rank test to assess the significance of differences. The Cox model was applied for prognostic factor analysis. Results Overall, there was no significant difference in survival between patients with and those without radiotherapy (P = 0.1532). When analysing the patients undergoing consolidative radiotherapy separately, these 25 patients showed significantly longer survival than the 72 patients with palliative radiotherapy (P = 0.0047), with a 3-year overall survival of 43.3%. Of the present cohort, 22 underwent metastasectomy for disease consolidation, and there was no overlapping case between the metastasectomy cohort and cohort receiving consolidative radiotherapy. After controlling for four independent prognostic factors (sex, performance status, haemoglobin level and number of organs with metastasis) in our previous study, radiotherapy for disease consolidation showed a marginal value (hazard ratio = 0.666, P = 0.0966), while metastasectomy remained significant (hazard ratio = 0.358, P = 0.0006). Conclusions In the selected patients, long-term disease control could be achieved after consolidative radiotherapy for metastatic urothelial carcinoma disease. Our observations suggest that local ablative therapy (surgery or radiotherapy) could facilitate long-term disease control. However, the treatment decision should be individualized because of the lack of randomized control trials.

Survival improvement by systemic chemotherapy in adult patients with recurrent glioblastoma multiforme treated with two courses of radiotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1578-1578
Author(s):  
C. Nieder ◽  
A. L. Grosu ◽  
S. Astner ◽  
N. Andratschke ◽  
M. Molls
Keyword(s):  
Overall Survival ◽  
Glioblastoma Multiforme ◽  
Surgical Resection ◽  
Cumulative Dose ◽  
Systemic Chemotherapy ◽  
Local Treatment ◽  
Adult Patients ◽  
External Beam ◽  
Median Cumulative Dose ◽  
First Diagnosis

1578 Background: We evaluated the added value of systemic chemotherapy (CTx) in adult patients with recurrent supratentorial glioblastoma multiforme (GBM) selected to receive local re-treatment (administered as a 2nd course of radiotherapy, RTx). Methods: Retrospective comparison of two patient cohorts treated subsequently during different time periods. All patients had histologically confirmed recurrent GBM. Minimum recurrence-free interval was 4 months. The first cohort (n=26) had surgical resection and standard postoperative external beam RTx followed by a second course of external beam RTx for recurrence (median cumulative dose 102 Gy). None of these patients ever received CTx during the whole course of disease. The more recently treated cohort (after 1999) of 19 patients also had surgical resection and 2 courses of external beam RTx (median cumulative dose 90 Gy). After primary local treatment, 9 of these patients had adjuvant nitrosourea-based CTx. At recurrence, all 19 patients received temozolomide 150–200 mg/m2/day for five days every 4 weeks in addition to RTx. Results: The cohort without CTx had less favorable baseline characteristics, because of their significantly lower median KPS at recurrence (70 vs. 90%, p<0.01) and shorter interval between primary diagnosis and recurrence (12 vs. 16 months, p<0.05). However, these patients were non-significantly younger (median age 44 vs. 50 years, p>0.05). The percentage of patients with secondary GBM was similar (21 vs. 23%, p>0.5). Median survival from re-irradiation was significantly better in the RTx plus CTx group, 9 vs. 5 months (p<0.05). In multivariate analysis, prognosis was significantly improved by CTx. Importantly, there was also an advantage when overall survival from first diagnosis was evaluated, median 24 vs. 19 months (p<0.05). Conclusion: The current data suggest that re-irradiation plus temozolomide is better than re-irradiation alone. CTx led to a prolongation of overall survival from first diagnosis by 5 months. The most intensively treated, prognostically favourable de-novo GBM patients had surgical resection, 2 courses of RTx and 2 different systemic CTx regimens. [Table: see text]

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