Retrospective analysis of multiparametric MRI to predict complete pathologic response after neo-adjuvant chemotherapy for muscle invasive bladder cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16535-e16535
Author(s):  
Daan De Maeseneer ◽  
Pieter De Visschere ◽  
Mats Van den Broecke ◽  
Geert Villeirs ◽  
Sofie Verbeke ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Likelihood Ratio ◽  
Bladder Wall ◽  
Multiparametric Mri ◽  
Pathologic Response ◽  
Invasive Bladder Cancer ◽  
Complete Pathologic Response ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
Very High

e16535 Background: Muscle invasive bladder cancer (MIBC) is a life-threatening disease. Treatment is multimodal combining neo-adjuvant cisplatin-based chemotherapy (NAC) and radical cystectomy (RC). Accurately predicting complete pathologic response (pCR) using multiparametric MRI (mpMRI) could impact peri-operatively treatment. Methods: MIBC patients receiving NAC were evaluated at our institution with mpMRI before, after 2 cycles and after 4 cycles of dose dense MVAC (ddMVAC). Response after 4 cycles was retrospectively assessed using the method earlier described by Necchi et al with blinding of the readers for the pathological result of RC. Two radiologists independently evaluated 3 questions: residual disease at T1/T2-weighted images, presence of spots of restrictive diffusion within the bladder wall on diffusion-weighted imaging, and presence of focal contrast enhancement in the bladder wall on dynamic contrast enhanced images. Radiographic complete response (rCR) was defined as “No” on all three questions. Results: A total of 46 patients were identified having received ddMVAC for urothelial MIBC. Six patients did not undergo RC after NAC and were excluded from this analysis. Eleven out of 40 (28%) patients showed a complete pathologic response (ypT0). Baseline characteristics were similar compared to non-complete pathologic responders ( > ypT0), with the exception of hydronephrosis (9% in ypT0 vs. 52% in > ypT0). mpMRI questions could be assessed in 37 of 40 patients (93%). rCR was seen in 5 patients and was significantly associated with pCR (1-sided p value 0.021). Although sensitivity was low (36%), specificity was very high (96%) of this 3-step assessment. Positive likelihood ratio was 9.45, negative likelihood ratio 0.66. Concordance of assessment was very high. Conclusions: Using the 3-step imaging approach of Necchi et al, mpMRI can predict pCR after neo-adjuvant cisplatin-based chemotherapy with high specificity but low sensitivity. mpMRI should be included in future trials of multimodal management of MIBC and is an important predictive asset in routine clinical management.[Table: see text]

scholarly journals Effectivity of intravescical thermo-chemotherapy prophylaxis for patients with high recurrence and progression risk for non-muscle invasive bladder cancer

2017 ◽  
Vol 89 (2) ◽  
pp. 102 ◽  
Author(s):  
Ali Serdar Gözen ◽  
Paolo Umari ◽  
Walter Scheitlin ◽  
Fuat Ernis Su ◽  
Yigit Akin ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Recurrent Disease ◽  
Bladder Wall ◽  
Invasive Bladder Cancer ◽  
Outpatient Basis ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Background&Aim: High grade non-muscle invasive bladder cancer (NMIBC) is common in urological practice. Most of these cancers are or become refractory to intravesical immunotherapy and chemotherapy. Here we evaluated the efficacy of combined local bladder hyperthermia and intravesical mitomycin-C (MMC) instillation in patients with high-risk recurrent NMIBC. Materials and methods: Between February 2014 and December 2015, 18 patients with high risk NMIBC were enrolled. Patients were treated in an outpatient basis with 6 weekly induction sessions followed by monthly maintenance sessions with intravesical MMC in local hyperthermia with bladder wall thermo-chemotherapy (BWT) system (PelvixTT system, Elmedical Ltd., Hod Hasharon, Israel). The follow-up regimen included cystoscopy after the induction cycle and thereafter with regular intervals. Time to disease recurrence was defined as time from the first intravesical treatment to endoscopic or histological documentation of a new bladder tumour. Adverse events were recorded according to CTC 4.0 (Common Toxicity Criteria) score system. Results: Mean age was 72 (32-87) years. 10 patients had multifocal disease, 9 had CIS, 6 had recurrent disease and 2 had highly recurrent disease (> 3 recurrences in a 24 months period). 6 patients underwent previous intravesical chemotherapy with MMC. The average number of maintenance sessions per patient was 7.6. After a mean follow-up of 433 days, 15 patients (83.3%) were recurrence-free. 3 patients had tumour recurrence after a mean period of 248 days without progression. Side effects were limited to grade 1 in 2 patients and grade 2 in 1 patient. Conclusions: BWT seems to be feasible and safe in high grade NMIBC. More studies are needed to identify the subgroup of patients who may benefit more from this treatment.

The efficacy and safety of EN BLOC resection in non-muscle-invasive bladder cancer

2020 ◽  
Vol 8 (1) ◽  
pp. 26-39
Author(s):  
E.A. Laukhtina ◽  
◽  
A.D. Shpikina ◽  
M.S. Taratkin ◽  
D.V. Enikeev ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Bladder Wall ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Invasive Tumour ◽  
Operative Complications ◽  
Muscle Invasive

In surgical treatment of non-muscle-invasive bladder cancer (BC) the en bloc resection technique – removal of tumour in a single piece with the subjacent muscle (detrusor) – is becoming more widely used. The objective of this review was to assess the oncological efficacy (relapse incidence) and safety (of peri- and post-operative complications) of this technique for various tumour sizes. This systematic review was written in accordance with the PRISMA criteria. The relevant literature published over the past 20 years was chosen in two databases (Medline and Scopus) with the use of the search query “en bloc” and “bladder cancer”. We selected publications that assessed the efficacy and safety of en bloc resection of the bladder wall with non-muscle-invasive tumour, and also publications comparing the efficacy of en bloc резекции resection with that of transurethral resection (TUR) of the bladder. Based on analysis of 18 studies (1592 patients after en bloc resection), the following conclusions were made: the incidence of BC relapses after en bloc resection of the bladder wall (with non-muscle-invasive tumour) is significantly lower than after conventional TUR of the bladder; a practically 100-percent presence of muscle fibers is found in the histological tumour specimen; the frequency of peri- and post-operative complications in en bloc resection is significantly lower as compared with classical TUR; the choice of a power source does not influence the oncological outcomes, but laser en bloc resection is safer than electrical; extraction of tumours with sizes up to 2-3 cm is possible in one piece; tumours of larger diameters should be preliminary fragmented in the bladder cavity; comparison of tumours of various diameters did not reveal any statistical differences between the oncological outcomes of patients. The technique of en bloc resection of the bladder wall with non-muscle-invasive tumour is effective and safe for removal of smaller tumours (~ to 2 cm); as some authors point out, it is also effective in larger tumours but there are no literature evidence sufficient for such an. Key words: systematic review, en bloc resection, non-muscle-invasive bladder cancer

Predictors of pathologic response after radical cystectomy for muscle invasive bladder cancer: A population-based analysis.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 503-503
Author(s):  
Shane M. Pearce ◽  
Akbar Ashrafi ◽  
Matthew Winter ◽  
Saum Ghodoussipour ◽  
Daniel Zainfeld ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Pathologic Response ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Academic Center ◽  
Muscle Invasive ◽  
Over Time

503 Background: Neoadjuvant chemotherapy (NAC) improves overall survival (OS) for patients with muscle invasive bladder cancer (MIBC) undergoing radical cystectomy (RC), possibly through an increase in pathologic complete response (CR), defined as a pathologic stage T0 (pT0). We sought to identify predictors of CR for MIBC. Methods: The National Cancer Database from 2004 to 2013 was used to identify patients with cT2-4cN0cM0 urothelial cell carcinoma treated with RC. Patients were grouped based on pathology as CR (pT0), partial response (PR – pTa/Tis/T1) or no response (NR - pT2 or higher). Predictors of NAC and CR were identified with multivariable logistic regression. Cox proportional hazards model was used to compare OS based on cT stage, receipt of NAC and pathologic response. Results: The study population included 10,820 patients and NAC was administered in 16.4%. Use of NAC was associated with higher cT stage (p < 0.01) and increased over time (10% from 2003-2007 vs. 24% from 2011-2013, p < 0.01). Predictors of NAC use on multivariable analysis include younger age, lower comorbidity score, treatment at an academic center, and diagnosis from 2011-2013 (p < 0.01). Overall, CR was achieved in 3.3% without NAC and 16.3% with NAC (p < 0.01). NAC improved 5-year OS for all cT stages, however the survival benefit was only observed among those achieving CR (p < 0.01). Multivariable Cox regression demonstrates that both PR (HR 0. 58, p < 0.01) and CR (OR 0.26, p < 0.01) were independently associated with improved OS among those treated with NAC. Multivariable analysis identified age (OR 0.98, p < 0.01) and increased clinical stage (cT3: OR 0.47, p < 0.01; cT4 OR 0.54, p < 0.01) as negative predictors of CR. Utilization of NAC (OR 4.82 p < 0.01), academic institution, and diagnosis 2011-2013 (OR 1.92, p < 0.01) increased the odds of CR. Conclusions: Use of NAC increased over time and CR occurred in 16% of patients who received NAC. Treatment at an academic center, diagnosis from 2011-2013 and use of NAC were independently associated with CR, while increased age and clinical stage were negative predictors of CR. PR and CR are independently associated with improved OS relative to non-responders.

Bladder-preserving therapy using a real-time tumor-tracking radiotherapy system for muscle-invasive bladder cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 364-364
Author(s):  
Haruka Miyata ◽  
Takahiro Osawa ◽  
Jun Frumido ◽  
Hiroshi Kikuchi ◽  
Ryuji Matsumoto ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Real Time ◽  
Primary Tumor ◽  
Bladder Wall ◽  
Univariate Analysis ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Tumor Bed ◽  
Tumor Tracking ◽  
Muscle Invasive

364 Background: Bladder-preserving therapy with a real-time tumor-tracking radiotherapy system (RTRT system) has been used for muscle-invasive bladder cancer (MIBC) since 1998 in our institution. We evaluate long term outcomes of this therapy. Methods: From 1998 to 2016, 38 patients with a T2-T4N0M0 bladder cancer who were clinically inoperable or refused surgery were enrolled. Transurethral tumor resection (TUR) and 40 Gy irradiation to the whole bladder was followed by TUR of the tumor bed (1st Evaluation) and endoscopic implantation of fiducial markers in the bladder wall around the primary tumor. Then, a boost of 25 Gy was made to the primary tumor using RTRT system. Protocol TUR of the tumor bed was performed 6 months later (2nd Evaluation). Patients with adequate renal function (CCR>45ml/min) received concurrent chemoradiotherapy with nedaplatin (cisplatin analog made in Japan, 70mg/m2 intravenously, day1, day22, day50). Results: Median follow-up for surviving patients was 6 yr. 5- and 10-yr OS were 55%, 40%, and 5- and 10-yr PFS were 55% and 39%, respectively. The CR rate at 1st evaluation was 66%, in those patients 5- and 10-yr OS rates were 70% and 61%. Among the patients with non-CR at 1st evaluation, CR rate at 2nd evaluation was 31%. Local recurrence occurred in 13 patients. One of them was performed cystectomy and 9 were performed TUR and/or bladder injection therapy. 11 patients experienced distant recurrence, 2 of those was performed chemotherapy. In univariate analysis, male (OS; HR: 0.33, 95% CI: 0.12-0.92, PFS; HR:0.25, 95% CI: 0.09-0.69) and PS0-1 (OS; HR: 0.26, 95% CI: 0.09-0.79, PFS; HR: 0.29, 95% CI: 0.10-0.85) were significantly associated with good OS and PFS (shown in Table). In multivariate analysis, the both of these covariates were also significantly associated with good OS and PFS (male; OS; HR: 0.31, 95% CI: 0.11-0.88, PFS; HR: 0.21, 95% CI: 0.07-0.62, PS0-1; OS; HR: 0.25, 95% CI: 0.08-0.76, PFS; HR: 0.24, 95%CI: 0.09-0.75). Conclusions: Bladder-preserving therapy is a considerable option in patients medically unfit for or not desiring cystectomy.

scholarly journals Mitofusin-2 Down-Regulation Predicts Progression of Non-Muscle Invasive Bladder Cancer

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1500
Author(s):  
Antonella Cormio ◽  
Gian Maria Busetto ◽  
Clara Musicco ◽  
Francesca Sanguedolce ◽  
Beppe Calò ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Disease Progression ◽  
Bladder Tumor ◽  
Bladder Wall ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Mitofusin 2 ◽  
Clinical Issue ◽  
Expression Levels ◽  
Muscle Invasive

Identification of markers predicting disease outcome is a major clinical issue for non-muscle invasive bladder cancer (NMIBC). The present study aimed to determine the role of the mitochondrial proteins Mitofusin-2 (Mfn2) and caseinolytic protease P (ClpP) in predicting the outcome of NMIBC. The study population consisted of patients scheduled for transurethral resection of bladder tumor upon the clinical diagnosis of bladder cancer (BC). Samples of the main bladder tumor and healthy-looking bladder wall from patients classified as NMIBC were tested for Mfn2 and ClpP. The expression levels of these proteins were correlated to disease recurrence, progression. Mfn2 and ClpP expression levels were significantly higher in lesional than in non-lesional tissue. Low-risk NMIBC had significantly higher Mfn2 expression levels and significantly lower ClpP expression levels than high-risk NMIBC; there were no differences in non-lesional levels of the two proteins. Lesional Mfn2 expression levels were significantly lower in patients who progressed whereas ClpP levels had no impact on any survival outcome. Multivariable analysis adjusting for the EORTC scores showed that Mfn2 downregulation was significantly associated with disease progression. In conclusion, Mfn2 and ClpP proteins were found to be overexpressed in BC as compared to non-lesional bladder tissue and Mfn2 expression predicted disease progression.

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