Characterization of urothelial carcinoma with seminal vesicle involvement in locally advanced bladder cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 440-440
Author(s):  
Simpa Samuel Salami ◽  
Aaron Udager ◽  
Brady Garland Miller ◽  
Ganesh S. Palapattu ◽  
Scott Tomlins ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Seminal Vesicle ◽  
Clinical Outcomes ◽  
Locally Advanced ◽  
Divergent Differentiation ◽  
Significant Difference ◽  
Advanced Bladder Cancer

440 Background: Muscle-invasive bladder cancer is associated with poor clinical outcomes, especially in locally advanced (pT4) disease. There is a paucity of data, however, regarding the clinical impact of seminal vesicle (SV) involvement. Therefore, we sought to characterize clinicopathologic features of patients with urothelial carcinoma involving seminal vesicles, and evaluate clinical outcomes in patients with locally advanced (pT4) bladder cancer with or without SV involvement. Methods: After institutional review board (IRB) approval, we retrospectively identified all men with pT4 (per the 7th edition of the AJCC Cancer Staging Manual) bladder cancer who underwent radical cystectomy between 2002 and 2013 at a single large academic institution. Clinicopathologic and follow-up data for all patients were obtained from the electronic medical record. The presence or absence of divergent differentiation, including aggressive forms (plasmacytoid, nested, micropapillary, and sarcomatoid), was recorded. Estimates of overall survival (OS) were compared by plotting Kaplan-Meier curves and using log-rank test. Results: A total of 62 patients were eligible for analysis. The median age and follow-up duration were 72 (range: 46 – 87) years and 12 (range: 0 – 141) months respectively. SV involvement was present in 17.7% (11/62) of patients. The frequency of divergent differentiation (including aggressive forms), angiolymphatic invasion, nodal disease (pN1-3), and positive soft tissue margins was relatively higher among those with SV involvement (not significant, all p >0.05). The 1 and 2-year OS for patients with SV involvement were 32.7% and 0% respectively, compared with 51.0 % and 24.9% respectively for patients without SV involvement. There was no statistically significant difference between the median OS of men with and without SV involvement (9 vs. 13 months, respectively; p = 0.19). Conclusions: In this relatively limited sample size cohort, we did not observe any difference in the overall survival of locally advanced bladder cancer patients with and without SV involvement.

MC (cisplatin and methotrexate) adjuvant chemotherapy after cystectomy versus MC neoadjuvant chemotherapy following cystectomy in locally advanced bladder cancer: Results after 10 years of experience

1995 ◽  
Vol 62 (1_suppl) ◽  
pp. 150-154
Author(s):  
L Rigoni ◽  
V. Scattoni ◽  
P. Rovellini ◽  
G. Pavia ◽  
A. Bottanelli ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Clinical Staging ◽  
Number Of Patients ◽  
Significant Difference ◽  
Advanced Bladder Cancer

— We report the results of a retrospective study of two groups of patients affected by locally advanced bladder cancer: the first group was submitted to adjuvant chemotherapy with Cisplatin and Methotrexate after cystectomy and the second group was submitted to neoadjuvant chemotherapy with the same scheme following radical cystectomy. The validity of the study is given by the homogeneity of the two groups for period of recruitment, number of patients, patient's age, stage of disease and treatment. The overall survival of 5 years in the first group was 30%, while the 5-year survival rate of the second group was 38%, 63% and 17% for all the patients, the responders and the nonresponders respectively. No significant difference in terms of survival was found between the two groups, but the results of the neoadjuvant approach may be influenced by clinical staging errors. The chemosensitivity, that can be assessed only with the neoadjuvant treatment, is the main prognostic factor.

Neoadjuvant Chemotherapy Plus Cystectomy Compared With Cystectomy Alone for Locally Advanced Bladder Cancer

2021 ◽  
pp. 141-146
Author(s):  
Vikram M. Narayan
Keyword(s):  
Adverse Effect ◽  
Overall Survival ◽  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Randomized Study ◽  
Locally Advanced ◽  
Common Adverse Effect ◽  
Advanced Bladder Cancer ◽  
Muscle Invasive

This study summarizes a landmark study on the role of neoadjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) in patients with muscle-invasive bladder cancer. This randomized study of M-VAC plus cystectomy versus cystectomy alone suggested improved overall survival in patients receiving neoadjuvant therapy. Severe granulocytopenia was a common adverse effect in the chemotherapy group, but no deaths were attributed to chemotherapy.

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.

Sequential salvage chemotherapy for CDDP-refractory advanced testicular cancer: Japanese high-volume center experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15526-e15526
Author(s):  
Terukazu Nakamura ◽  
Yasunori Kimura ◽  
Takashi Ueda ◽  
Yoshio Naya ◽  
Fumiya Hongo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Testicular Cancer ◽  
Clinical Outcomes ◽  
High Volume ◽  
Salvage Chemotherapy ◽  
Line Therapy ◽  
Significant Difference ◽  
High Volume Center ◽  
Advanced Testicular Cancer

e15526 Background: Chemotherapy- refractory or resistant GCTs, so called ‘difficult-to-treat’ GCTs would remain continuously disease-free with salvage chemotherapy or surgery. The optimal salvage chemotherapy remains unclear. The aim of this study was to assess the efficacy of ‘sequential’ chemotherapy for advanced testicular cancer. Methods: Salvage chemotherapy was required in 129 patients out of 233 advanced GCTs treated at Kyoto Prefectural University of Medicine from June, 1998 to December, 2011. Clinical outcomes were retrospectively assessed. Results: Median age was 31 year-old (range:17-65y.o.). Non-seminoma was in 111 cases (86.0%). IGCCC showed good in 37 cases (28.9%), intermediate 33 (25.6%), poor 47 (36.4%), and unknown 12 (9.1%). As the 2nd line therapy, VIP/VeIP and TIP/N therapy were done in 43 (33.3%) and 49 cases (38.0%), respectively. With regard to the patients requiring 3rd line or more chemotherapy, 95, 67, 40, 26 cases had 3rd, 4th, 5th and 6th line or more chemotherapy, respectively. TIN therapy was performed in 48 patients as 3rd line and in 24 patients as 4th line. Irinotecan-containing chemotherapy was done in 24 and 36 cased as 2nd +3rd line therapy and 4th line or more, respectively. Gemcitabine-containing therapy was done in 33 cases with 3rdline or more chemotherapy. Overall survival rate at median follow-up period was 71.0%at median follow-up of 48m. Overall survival stratified by IGCCC was shown in the figure. There was no significant difference between any two groups. Clinical outcomes showed no evidence of disease (NED) was obtained in 86.1% with second line therapy. Noteworthy mentioned, about 40% patients had NED even in the 4thline or more chemotherapy group. Conclusions: Relatively good prognosis was obtained in the patients with salvage chemotherapy at Japanese high volume center. Sequential continuous chemotherapy would be very important to manage ‘difficult-to-treat’ advanced germ cell tumors.

Effectiveness of Adjuvant Chemotherapy for Locally Advanced Bladder Cancer

2016 ◽  
Vol 34 (8) ◽  
pp. 825-832 ◽  
Author(s):  
Matthew D. Galsky ◽  
Kristian D. Stensland ◽  
Erin Moshier ◽  
John P. Sfakianos ◽  
Russell B. McBride ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Adjuvant Chemotherapy ◽  
Propensity Score ◽  
Observational Study ◽  
Performance Status ◽  
Locally Advanced ◽  
Median Income ◽  
Advanced Bladder Cancer ◽  
The Impact

Purpose Given that randomized trials exploring adjuvant chemotherapy for bladder cancer have been underpowered and/or terminated prematurely, yielding inconsistent results and creating an evidence gap, we sought to compare the effectiveness of cystectomy versus cystectomy plus adjuvant chemotherapy in real-world patients. Patients and Methods We conducted an observational study to compare the effectiveness of adjuvant chemotherapy versus observation postcystectomy in patients with pathologic T3-4 and/or pathologic node-positive bladder cancer using the National Cancer Data Base. We compared overall survival using propensity score (–adjusted, –stratified, –weighted, and –matched) analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to examine the impact of performance status. Results A total of 5,653 patients met study inclusion criteria; 23% received adjuvant chemotherapy postcystectomy. Chemotherapy-treated patients were younger and more likely to have private insurance, live in areas with a higher median income and higher percentage of high school–educated residents, and have lymph node involvement and positive surgical margins (P < .05 for all comparisons). Stratified analyses adjusted for propensity score demonstrated an improvement in overall survival with adjuvant chemotherapy (hazard ratio, 0.70; 95% CI, 0.64 to 0.76), and similar results were achieved with propensity score matching and weighting. The association between adjuvant chemotherapy and improved survival was consistent in subset analyses and was robust to the effects of poor performance status. Conclusion In this observational study, adjuvant chemotherapy was associated with improved survival in patients with locally advanced bladder cancer. Although neoadjuvant chemotherapy remains the preferred approach based on level I evidence, these data lend further support for the use of adjuvant chemotherapy in patients with locally advanced bladder cancer postcystectomy who did not receive chemotherapy preoperatively.

scholarly journals Hemoglobin Level as a Prognostic Factor for Locally Advanced Bladder Cancer Patients Treated with Radical Radiotherapy

2020 ◽  
pp. 48-56
Author(s):  
Mohamed S. Zahi ◽  
Waleed N. Abozeed ◽  
Skoukri H. Elazab
Keyword(s):  
Bladder Cancer ◽  
Prognostic Factor ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Hemoglobin Level ◽  
Common Symptom ◽  
Radical Radiotherapy ◽  
Significant Difference ◽  
Advanced Bladder Cancer ◽  
Pre Treatment

Anemia is a common symptom in cancer patients and usually associated with poor prognosis. Urinary bladder cancer (BC) is the most common cancer in the urological tract with anemia being one the most common presenting symptom. Radical radiotherapy is the treatment of choice for advancer disease with many factors could influence the prognosis. Aim: To identify pre-treatment hemoglobin level as prognostic factor for advanced bladder cancer treated with radiotherapy. Materials and Methods: A retrospective study reviewed the data of 88 patients with advanced bladder cancer, treated with radical radiotherapy from 2013 to 2018. Results: Median follow-up was 45 months. The median PFS was 26.87 months but when comparing anemic to non–anemic patient there was significant difference (17.25 and 40.02 months) respectively. Also as regards overall survival the median was 28.98 months but 20.24 and 40.47 months in anemic and non-anemic patients respectively with significant difference. Local or distant progression detected in 36 out of 50 anemic patients compared to only 4 out of 38 non-anemic patients. In multivariate analysis anemia was proved to be the strongest predictor of mortality. Conclusion: Pre-treatment Hb level is an important factor affecting the prognosis of advanced bladder cancer patients treated with radical radiotherapy. Low HB level could be considered as a good biological marker for aggressive disease.

A randomized clinical trial comparing adjuvant radiation versus chemo-RT versus chemotherapy alone after radical cystectomy for locally advanced bladder cancer.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 356-356 ◽  
Author(s):  
Mohamed S. Zaghloul ◽  
John Paul Christodouleas ◽  
Andrew Smith ◽  
Ahmed Abdalla ◽  
Hany William ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Significant Difference ◽  
Advanced Bladder Cancer ◽  
Grade 3

356 Background: There is growing interest in using adjuvant radiation therapy (RT) to reduce local failures (LF) after radical cystectomy (RC) for locally advanced bladder cancer. A previous RCT demonstrated significantly improved LF & OS with adjuvant RT vs. RC alone. An RCT was performed to compare the efficacy of adjuvant RT vs chemo-RT vs chemo alone after RC. The primary endpoint was disease-free survival (DFS). Secondary endpoints were OS, LRFS, DMFS and toxicity. Methods: Patients ≤ 70 yrs with ECOG PS ≤ 2 with locally advanced bladder cancer and ≥ 1 high-risk feature who underwent RC with negative margins at the Egyptian National Cancer Institute from 2002 – 2008 were enrolled. High risk features included stage ≥ pT3b, grade 3, or positive nodes. Patients were randomized following RC to RT (45 Gy in 1.5 Gy/fx given BID with 3D-conformal RT), chemo-RT with 2 cycles of gemcitabine/cisplatin before and after RT, or 4 cycles of chemo alone. The chemo alone arm was added as a 2nd randomization in 2007. Patients were followed regularly with CT scans q 6 months in the first 2 years & then yearly. Results: 198 patients were enrolled. 78 received RT, 75 chemo-RT and 45 received chemo alone. Median age was 54 (range 27 – 70) and the M:F ratio was 4:1. 53% had urothelial carcinoma, 41% had SCC and 6% other. Median follow-up was 19 mo (range 1 – 127 mo). The RT, chemo-RT and chemo alone arms had similar characteristics except for age (median 55, 52 and 55, respectively, p = 0.03) and tumor size (p = 0.02). There was no significant difference in DFS, DMFS or OS, although there was a trend toward improved DFS favoring the RT-containing arms with 3 yr rates of 63%, 68% and 56% in the RT, chemo-RT and chemo arms (p = 0.25). LRFS was significantly improved for the RT arms vs. chemo alone, with 3 yr rates of 87%, 96% and 69% (p < 0.01), regardless of histology. Treatment was reasonably well-tolerated with late grade ≥ 3 GI toxicity of 8%, 7% & 2%, respectively. Conclusions: This is the first RCT comparing adjuvant RT (+/- chemo) vs. adjuvant chemo following cystectomy for bladder cancer. RT was associated with significantly improved local control compared to chemo alone. There was no significant difference in DFS, DMFS, or OS. Clinical trial information: NCT01734798.

PS02.162: THREE-YEAR OVERALL SURVIVAL UPDATE FROM PHASE II STUDY OF CHEMOSELECTION WITH DCF AND SUBSEQUENT CONVERSION SURGERY FOR LOCALLY ADVANCED UNRESECTABLE ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 167-168
Author(s):  
Tomoya Yokota ◽  
Ken Kato ◽  
Yasuo Hamamoto ◽  
Yasuhiro Tsubosa ◽  
Hirofumi Ogawa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Phase Ii ◽  
Locally Advanced ◽  
R0 Resection ◽  
Conversion Surgery ◽  
Significant Difference ◽  
Subsequent Conversion ◽  
The Impact

Abstract Background A multicenter phase II trial revealed that docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy (IC) and subsequent conversion surgery (CS) was tolerable and effective in patients with locally advanced unresectable esophageal cancer (LAUEC) (Br J Cancer 2016;115:1328–1334). Here, we report updated 3-year analyses to further characterize the impact of DCF-IC followed by CS. Methods Esophageal cancer patients with clinical T4 disease and/or unresectable supraclavicular lymph node metastasis were eligible. The treatment starts with 3 cycles of DCF-IC, followed by CS if resectable, or by concurrent radiation plus chemotherapy with 5-fluorouracil and cisplatin (CF-RT) if not resectable. This updated analysis represents 3-year overall survival (OS), 3-year progression free survival (PFS), location of relapse, and subsequent therapy. Results As of October 11, 2017, 25 patients were dead. The median follow-up period in patients surviving without death was 39.3 months (95%CI: 38.7 - 41.7months). The estimated 1-year OS was 66.7% and lower limit of 95% confidence interval was 54.6%. The estimated 3-year OS was 46.6% (95% CI; 34.2 - 63.5%). The OS for patients who underwent R0 resection (n = 19) was significantly longer than those who did not undergo R0 resection (3-year OS: 71.4% vs. 30.1%). The estimated 1-year PFS was 50.6% (95%CI: 38.1 - 67.3%) and the estimated 3-year PFS was 39.6% (95%CI: 27.7 - 56.6%). The PFS for patients who underwent R0 resection (n = 19) was significantly longer than those who did not undergo R0 resection (3-year PFS: 61.3% vs. 25%). The recurrence or progression in primary site was observed in 31% of non R0 group. There was no significant difference in the rates of distant metastasis between the two groups (non R0 group vs. R0 group; 21% vs. 16%). The subsequent therapy after protocol therapy included chemotherapy (n = 18), radiotherapy (n = 11), and surgery (n = 5). Conclusion This longer follow up of DCF-IC followed by CS strategy for patients with LAUEC revealed promising OS and PFS. Based on this phase 2 trial, JCOG1510, a prospective randomized controlled trial to compare chemoselection with DCF-IC followed by CS versus CF-RT as a standard treatment is in preparation for LAUEC. Disclosure All authors have declared no conflicts of interest.

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