Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer

2021 ◽  
pp. 1-9
Author(s):  
Emmanuelle Fabiano ◽  
Catherine Durdux ◽  
Bertrand Dufour ◽  
Arnaud Mejean ◽  
Nicolas Thiounn ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Invasive Bladder Cancer ◽  
Long Term Outcomes ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Long-term outcomes after bladder-preserving combined-modality therapy for patients with muscle-invasive bladder cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 398-398
Author(s):  
Nicholas J Giacalone ◽  
Rebecca Helen Clayman ◽  
William U. Shipley ◽  
Andrzej Niemierko ◽  
Niall M. Heney ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Combined Modality Therapy ◽  
Cox Proportional Hazards ◽  
Invasive Bladder Cancer ◽  
Long Term Outcomes ◽  
Muscle Invasive Bladder Cancer ◽  
Combined Modality ◽  
Alternative Treatment Strategy ◽  
Muscle Invasive

398 Background: Transurethral resection of bladder tumor (TURBT), chemotherapy (CT), and radiation therapy (RT) is an established treatment paradigm for muscle-invasive bladder cancer (MIBC). Herein we report long-term outcomes for MIBC patients treated with combined-modality therapy (CMT). Methods: We analyzed 465 patients with MIBC (cT2-T4a) treated on successive protocols at a single center between 1986 and 2012. Patients underwent TURBT followed by concurrent cisplatin-based chemoradiation (CRT). A subset of patients received neoadjuvant CT. Repeat cystoscopy was performed after 40 Gy. Patients with a complete response (CR) received consolidation CRT to 64-65 Gy, while those with less than a CR or invasive recurrence were recommended to undergo salvage RC. Overall survival (OS) and disease-specific survival (DSS) were evaluated using Kaplan-Meier method and Cox proportional hazards regression. Results: Median follow-up was 4.8 years for all patients and 7.5 years for surviving patients. CR to induction CRT was achieved in 76% patients; 84% of patients with a complete TURBT achieved a CR vs. 59% with an incomplete TURBT, p< 0.001. When evaluated in four-year intervals, the CR rate improved from 64% in 1986-1990 to 96% in 2010-2012. Salvage RC was performed in 125 patients (27%), 55 for less than CR and 70 for superficial or invasive recurrence. Among patients with a CR, the 10-year actuarial rates for non-invasive, invasive, pelvic, and distant failure were 32%, 16%, 14%, and 29%, respectively. Median OS was 6.4 years. Five- and 10-year OS rates were 57% and 39% (T2 = 66%, 46%; T3-T4a = 41%, 26%), respectively. Five- and 10-year DSS rates were 66% and 59% (T2 = 75%, 66%; T3-T4a = 50%, 45%), respectively. In multivariate analyses, T2 disease (vs. T3-4; HR 0.55, 95%CI 0.40-0.76) and CR to induction therapy (HR 0.40, 95%CI 0.28-0.55) were significant predictors for improved OS. Age was not associated with DSS (HR 1.01, 95%CI 0.99-1.03). Conclusions: These data support the high rates of CR and bladder preservation in patients receiving CMT, and demonstrate long-term DSS similar to modern cystectomy series. CMT should be considered as an alternative treatment strategy for selected patients with MIBC.

Long-term outcomes among BCG-treated high-risk non-muscle invasive bladder cancer patients in an equal access setting.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17031-e17031
Author(s):  
Stephen B. Williams ◽  
Lauren Howard ◽  
Meagan Foster ◽  
Zachary William Abraham Klaassen ◽  
Jan Sieluk ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Economic Burden ◽  
Equal Access ◽  
Invasive Bladder Cancer ◽  
Long Term Outcomes ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

e17031 Background: Management of high-risk non-muscle invasive bladder cancer (HR NMIBC) represents a clinical challenge due to high failure rates despite prior bacillus Calmette-Guérin (BCG) therapy. We describe real-world patient characteristics, long-term outcomes, as well as the economic burden in the HR NMIBC population. Methods: We identified a random sample of 412 HR NMIBC patients who received ≥ 1 dose of BCG within Veterans Affairs (VA) centers across the United States from January 1, 2000, to December 31, 2016. HR NMIBC was defined as high-grade Ta (TaHG), T1, and/or carcinoma-in-situ (CIS). We analyzed the number of BCG instillations received, as well as used the Kaplan-Meier method to estimate event-free survival for cystectomy and bladder cancer-specific death. All-cause expenditures were summarized as medians with corresponding interquartile ranges (IQR) and adjusted to 2019 USD. Results: The median (IQR) age at diagnosis was 67 years (61-74), with most patients being white (84%) and male (81%). At HR NMIBC diagnosis, 69 (17%) patients had CIS +/- T1 or TaHG, and 341 (83%) had TaHG or T1, no CIS. The vast majority of patients [n = 363, (90%)] received six BCG instillations (range: 1-7) within 365 days of the first dose. The total follow-up was 2,694 person-years. From BCG initiation to end of follow-up, the median all-cause expenditures per patient were $358,593 (257,699 – 652,853). Conclusions: In this equal access setting, the vast majority of HR NMIBC patients received 6 instillations of BCG within 1 year, although the interval over which the instillations were given varied among patients. Patients with CIS appeared to have a worse prognosis, as 24% underwent cystectomy, and 13% died of bladder cancer at 10 years of follow-up. These findings also highlight the considerable economic burden of HR NMIBC. [Table: see text]

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