Contemporary utilization trends and survival outcomes in patients undergoing radical cystectomy and bladder preservation therapy for muscle invasive bladder cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 387-387
Author(s):  
David Cahn ◽  
Elizabeth Handorf ◽  
Michael Nordsiek ◽  
Thomas M. Churilla ◽  
Eric M. Horwitz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Selection Criteria ◽  
Cox Regression ◽  
External Beam Radiotherapy ◽  
Stage Ii ◽  
Bladder Preservation ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive

387 Background: To compare overall survival (OS) in patients undergoing radical cystectomy (RC) and bladder preservation therapy (BPT) for muscle invasive urothelial carcinoma of the bladder. Methods: We conducted a retrospective, observational cohort study in which we reviewed the National Cancer Database (NCDB) to identify patients with analytic stage II-III (N0M0) urothelial carcinoma of the bladder from 2003-2011. BPT patients were stratified as any external beam radiotherapy (EBRT), definitive radiotherapy (RT) [50-80Gy], and definitive RT + chemotherapy. Treatment trends were evaluated using Pearson Chi-square tests. OS was compared between RC and BPT using unadjusted Kaplan Meier curves and Cox regression models adjusted for year of treatment, hospital volume, and patient/tumor characteristics using increasingly stringent selection criteria to identify those undergoing BPT. Results: Of the 603,298 patients with bladder cancer captured in the NCDB from 2003-2011, 9% (n = 54,518) had analytic stage II-III with urothelial histology. 51.1% (n = 27,843) of these patients were treated with RC (70.9%, n = 19,745) or BPT (29.1%, n = 8,098). Of the patients undergoing BPT, stratified by selection criteria, 26.9% (n = 2,176) and 15.0% (n = 1,215) were treated with definitive RT and definitive RT + chemotherapy, respectively. Following adjustment, improved survival in patients undergoing RC was noted regardless of BPT definition employed in multivariate analysis. However, we noted attenuated differences in OS using increasingly stringent definitions for BPT (EBRT: HR 2.2 [CI 2.15-2.29]; definitive RT: HR 1.94 [CI 1.74-2.14]; definitive RT + chemotherapy: HR 1.56 [CI 1.45-1.68]). Conclusions: In the NCDB, receipt of BPT was associated with decreased OS compared to RC in all patients with stage II-III urothelial carcinoma, in part due to selection biases. However, the use of increasingly stringent definitions of BPT attenuated the observed survival differences. Further randomized prospective controlled trials are needed to compare trimodal BPT to RC to identify optimal candidates for bladder preservation.

scholarly journals A Case of Primary Small-Cell Carcinoma of the Bladder

2016 ◽  
Vol 9 (3) ◽  
pp. 574-579 ◽  
Author(s):  
Ashita Ono ◽  
Yosuke Hirasawa ◽  
Mitsumasa Yamashina ◽  
Naoto Kaburagi ◽  
Takashi Mima ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Cell Carcinoma ◽  
Radical Cystectomy ◽  
Small Cell Carcinoma ◽  
Distant Metastasis ◽  
Small Cell ◽  
Common Type ◽  
Cell Of Origin ◽  
Carcinoma Of The Bladder

Primary small-cell carcinoma arising from the bladder (SmCCB) is uncommon. It differs from urothelial carcinoma (UC), the most common type of bladder cancer, with respect to its cell of origin, biology, and prognosis. Biologically, prostatic SmCCB is much more aggressive than UC, and the prognosis for cases with distant metastasis is especially poor. We report here a case of primary SmCCB (cT3bN1M0) treated with radical cystectomy.

The impact of histologic variants of urothelial carcinoma on clinical outcomes following trimodal bladder-preserving therapy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 421-421
Author(s):  
Yoshiyuki Nagumo ◽  
Shuya Kandori ◽  
Tomokazu Kimura ◽  
Takashi Kawahara ◽  
Takahiro Kojima ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Clinical Outcomes ◽  
Invasive Bladder Cancer ◽  
Rank Test ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Significant Difference ◽  
Muscle Invasive ◽  
The Impact

421 Background: The current guidelines for muscle-invasive bladder cancer recommend the use of neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy. However, a trimodal approach involving the combination of maximal transurethral resection (TUR) and combined chemoradiotherapy is an alternative in selected patients. Clinical outcomes of patients with histologic variants have not well been known. Methods: From 1990 to 2015, 148 patients with cT2-3N0M0 muscle-invasive bladder cancer underwent trimodal bladder-preserving therapy consisting of maximal TUR of the bladder tumor, intra-arterial chemotherapy and radiotherapy at our institution. We compared complete response rate (CRR) of bladder preservation, 5-yr cause-specific survival (CSS), and 5-yr overall survival (OS) for the patients with pure urothelial carcinoma (UC) or variant UC. OS and CSS were analyzed by using the Kaplan-Meier method and log-rank test. Results: The median follow-up was 38.3 months. All patients were T2-T3N0M0 (T2, n = 90; T3, n = 58). There were no significant differences in clinical characteristics between pure and variant UC groups. Eleven (7%) of the 148 patients had variant UC; 7 (64%) had UC with squamous and/or glandular differentiation, and 4 (36%) had other forms, including sarcomatoid (n = 1), plasmacytoid (n = 1), signet ring cell (n = 1), and clear cell variants (n = 1). There was no significant difference between pure UC and variant UC for CRR of bladder preservation (85% vs 82%, p = 0.66), the 5-yr CSS (88% vs 75%, p = 0.86) and the 5-yr OS (81% vs 75%, p = 0.66). Conclusions: Our findings indicate that trimodal bladder-preserving therapy can be an effective treatment option for selected muscle-invasive bladder cancer patients with variant UC.

Phase II trial of durvalumab plus tremelimumab with concurrent radiotherapy as bladder-sparing therapy in patients with localized muscle invasive bladder cancer: A SOGUG study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS5097-TPS5097
Author(s):  
M. Andres Cuellar ◽  
Ana Medina ◽  
Regina Girones ◽  
B.P. Valderrama ◽  
Albert Font ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Bladder Cancer ◽  
Phase Ii ◽  
External Beam Radiotherapy ◽  
Human Monoclonal Antibody ◽  
Pathological Response ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Muscle Invasive

TPS5097 Background: Several studies have shown that long-term bladder preservation is feasible in selected patients with muscle-invasive bladder cancer, using a multimodal treatment, including transurethral resection (TUR), radiotherapy and chemotherapy. Durvalumab, a fully human monoclonal antibody against PD-L1, has shown activity in patients with advanced pretreated urothelial cancer. A preclinical study showed that the combination of radiation, anti-CTLA4 and anti-PD-L1 overcome- adaptive immune resistance and has superior activity than either therapy alone (Twyman-Saint Victor et al. Nature 2015). The purpose of the present study is to explore feasibility, toxicity and activity in terms of response and bladder preservation of the integration of TUR, immune double checkpoint inhibition with durvalumab and tremelimumab (a fully human monoclonal antibody against CTLA-4), and radiotherapy in the treatment of localized muscle-invasive. Methods: This is a multicenter prospective phase II study of multimodal therapy in patients with localized urothelial carcinoma of the bladder in clinical stages T2-4a N0 M0, ECOG 0- 1, without contraindications to immunotherapy, who either wish for bladder preservation or are ineligible for cystectomy. The primary endpoint is pathological response (≤T1) at post-treatment biopsy. A 2-stage sequential design (response rate P0=5, P1=0.7, α=0.10, β=0.20) requires at least 6 responses in the first 12 pts to expand to a second cohort of 20 patients. The treatment consists of initial TUR of the tumor, followed by durvalumab 1500 mg i.v. plus tremelimumab 75 mg i.v., every 4 weeks for 3 doses. Normofractionated external-beam radiotherapy is started 2 weeks later, at doses of 46 Gy to the minor pelvis and 64-66 Gy to the bladder. Patients with pathological response will be candidates to bladder preservation, whereas those with residual muscle invasive tumor will be candidates to salvage cystectomy. At present time, prespecified activity goal for the first stage of accrual was met; second stage accrual began in December 2019. Clinical trial information: NCT03702179 .

scholarly journals Complications of radical cystectomy for bladder cancer

2018 ◽  
Vol 6 (12) ◽  
pp. 3898
Author(s):  
Maliikarjuna Gurram ◽  
Ravichander G. ◽  
Ravi Jahagidar ◽  
Vinay Reddy
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Bladder Tumor ◽  
Invasive Bladder Cancer ◽  
Safe Procedure ◽  
High Grade ◽  
Early Complications ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Background: Radical cystectomy with pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. With the advent of improved surgical techniques and postoperative management, the complications and mortality rates have reduced. The present study was done to analyse the perioperative, early and late compilations following radical cystectomy for bladder tumor.Methods: This is a prospective observational study of patients who underwent radical cystectomy for invasive bladder tumor from February 2016 to November 2017. Radical cystectomy was done through midline transperitoneal approach.  Urinary diversion was done by ileal conduit. All patients were followed at 6th week, 3rd month, 6th month, and at 1 year.Results: Total 21 patients underwent radical cystectomy, 17(80.95%) were males and 4 (19.04%) females. The median age was 60 years, ranging from 40 to 73 years. The   most common age group was 60 to 75 years (52.3%). Thirteen (61.9%) patients were smokers and all were males. Painless haematuria alone was most common presentation (of bladder tumor) seen in 15 (71.4%) patients. Early complications were seen in 8 (38.09%) patients, most common early complication was urinary leak 2 (9.5%) patents, other early complications were bowel leak, wound dehiscence, pelvic collection, burst abdomen, prolonged ileus, subacute intestinal obstruction, acute kidney injury and sepsis seen in one (4.25%) patient each. Late complications were seen in 4 (19.04%) patients.  Pelvic recurrence was the most common late complication seen in 2 (9.55%) patients. Ureteric stricture was seen in one patient (4.75%) for which percutaneous nephrostomy and antegrade DJ stenting was done. Among the histopathological variants of tumor 20 (95.25%) patients had high grade variants and only one (4.75%) had low grade papillary urothelial carcinoma. Among the high grade variants most common pathology was urothelial carcinoma in 17 (80.9%) patients.Conclusions: Radical cystectomy remains the main stay of treatment in muscle-invasive bladder cancer. This is relatively safe procedure with minimal morbidity and mortality.

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