The role of partial cystectomy in treatment of muscle invasive bladder cancer

Muscle invasive bladder cancer is usually treated by radical cystectomy, but in some selected cases with solitary tumor with appropriate localization partial cystectomy can be the treatment of choice achieving long term results with bladder preservation. We reviewed records of 11 patients which were treated in 5 year period from June 2002 to June 2007. by partial cystectomy according to the size of the tumor, localization, histology, multifocality, pathological and clinical stage, sex, and age. Male: female ratio was 6:5, mean age of the patients being 64.9 years. All patients bur one had solitary lesions located in the bladder dome in 4, on lateral sides in 5,2 patients had a tumor in diverticulum. TCC gr II was diagnosed 6 pts, TCC gr III in 5. One patient died in a year from disease progression, one from other reason, while all other patients are alive and disease free, the longest disease free interval being 3 years. Bladder capacity is adequate in all patients resulting in good quality of life .Our results suggest that in selected patients cancer control can be achieved with partial cystectomy.

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The efficacy of trimodal chemoradiotherapy with gemcitabine and cisplatin as a bladder-preserving strategy for the treatment of muscle invasive bladder cancer: A single-arm prospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.516 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 516-516

Author(s):

Hiroaki Matsumoto ◽

Kazuhiro Nagao ◽

Sho Ozawa ◽

Masahiro Samoto ◽

Junichi Mori ◽

...

Keyword(s):

Bladder Cancer ◽

Clinical Stage ◽

Good Prognosis ◽

Response To Treatment ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Bladder Preservation ◽

Cancer Specific Survival ◽

Free Survival ◽

Muscle Invasive

516 Background: Radical cystectomy is still the standard treatment for muscle-invasive bladder cancer (MIBC), while the patients with MIBC are not always appropriate candidates due to multiple comorbidities. We establish novel treatment strategy by trimodal treatment. Methods: The regimen was gemcitabine 300 mg/m2, and cisplatin 30mg/m2 in day 1 and concomitant irradiation 2Gy/Fr, 5 fraction per week. Irradiation was administered to whole pelvis up to 30Gy, then boost to true pelvis until total 48Gy to 54Gy. Extensive transurethral resection (TURBT) was performed and we confirmed pathological stage ≥T2. TURBT was also performed after chemoradiotherapy to evaluate the pathological response to treatment. This study was approved in our institutional review board (ID: H23-89) and the information was opened on UMIN (ID: UMIN000006363). We analyzed their treatment efficacy and survival. Results: The patients were 29 men and 9 women, median age was 76.5 y.o. and median follow up was 23 months (1 - 112). Clinical stage T2, T3, T4, N1 and N2 were 23, 10, 5, 4, 2 cases, respectively. The 2- and 5-year metastatic-free survival (MFS), bladder-recurrence free survival (bRFS), cancer-specific survival (CSS), and overall survival (OS) rates after treatment were 91.7 and 84.0%, 59.7 and 42.6%, 87.3 and 87.3%, and 87.3 and 81.8%, respectively. Salvage cystectomy was performed 3 patients and they were still alive. CR rate was 78.9% and overall response rate was 92.1%. cT stage and valiant histology was not associated with treatment response. The patients achieved CR had significant good prognosis in CSS (p=0.0149) and OS (p=0.0149) compared with non-responders. In cox hazard model, CR achievement was significant prognostic factors for OS (p =0.0015, HR 6.804e+26, 95% CI 56.94-1.631e+86). Patients were able to receive 3 to 5 cycle GC radiation and any grade 3 or more adverse event was 7 (18.4%) cases. no treatment related death was recorded. Conclusions: In selected patients, GC radiation for MIBC may provide good oncological outcomes as bladder preservation strategy.

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Intra-Arterial Chemotherapy for Muscle-Invasive Bladder Cancer Following Transurethral Resection

Urologia Internationalis ◽

10.1159/000369301 ◽

2015 ◽

Vol 94 (4) ◽

pp. 406-411 ◽

Cited By ~ 6

Author(s):

Shengjie Liang ◽

Qingsong Zou ◽

Bangmin Han ◽

Yifeng Jing ◽

Di Cui ◽

...

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Clinical Stage ◽

Complete Response ◽

Intravesical Instillation ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Bladder Preservation ◽

Muscle Invasive

Purpose: To assess the efficacy of intra-arterial chemotherapy as a bladder-preservation treatment in patients with muscle-invasive bladder cancer (MIBC) following transurethral resection of bladder tumors (TURBT). Materials and Methods: From 2005 June to 2012 November, 46 patients diagnosed with MIBC (clinical stage T2-T3N0M0) underwent three courses of cisplatin-based intra-arterial chemotherapy as a remedial approach for bladder preservation after TURBT. All patients also received intravesical instillation of chemotherapy as a maintenance strategy. Results: All 46 patients completed the treatment with minor complications. The median follow-up time was 34.5 months (range, 8-87 months). Thirty-two patients (69.6%) demonstrated complete response. The three-year and five-year overall survival was 70.65 and 61.23%, and the disease-specific survival over the same periods was 78.03 and 67.62%, respectively. During the entire follow-up period, more than 80% preserved their bladder. Conclusions: Intra-arterial chemotherapy can be performed as a remedial treatment for MIBC patient following TURBT. Combined with TURBT, it offers an option for bladder preservation therapy on patients who are unable or unwilling to undergo radical cystectomy.

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Expression of EGFR, HER-2 and p53 predictive of prognosis in muscle-invasive bladder cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15637 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15637-15637 ◽

Cited By ~ 1

Author(s):

W. Sakr ◽

S. Marur ◽

M. Che ◽

L. Heilbrun ◽

D. Smith ◽

...

Keyword(s):

Bladder Cancer ◽

Survival Data ◽

Clinical Stage ◽

Prognostic Significance ◽

Growth Factor Receptor ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Female Ratio ◽

Her 2 ◽

Muscle Invasive

15637 Background: The significance of over expression of Erb-1 (epidermal growth factor receptor/ EGFR) and Erb-2 (Her-2) has been reported in various tumors. The aim of this study was to investigate the correlation of the expression of EGFR, Her-2 and p53 with relapse free survival (RFS) and over all survival (OS) in patients with muscle invasive bladder cancer Methods: All patients with muscle invasive bladder cancer diagnosed at our institution between1993and 2004 were considered for the study. Immunohistochemical staining for EGFR, Her2 and p53 performed on formalin-fixed paraffin-embedded archival tissue was evaluated as positive or negative without knowledge of clinical outcome. Survival data determined by reviewing patients medical records were correlated with the staining results. Results: Of the 46 patients who qualified for the study, 40 had slides interpretable for Her 2 and p 53 staining and 38 had slides interpretable for EGFR staining. 35 of 38 were EGFR +ve, 22/40 were Her-2 +ve and 12/40 were p53+ve. The median age of the 46 patients was 67.5 years with a male/female ratio of 60% and 40%. 83% had clinical Stage 2; of those 42%, 23%, and 35% had pathological stages T2, T3 and T4 respectively. Six of 46 (13%), received adjuvant therapy. Tumor histology was pure transitional carcinoma in 56%, or with other components (squamous or adenocarcinoma) in 44%. Median follow-up was 48.8 months for RFS and 44.9 months for OS. Patients with positive EGFR had a median RFS of 34.8 months and median OS of 59.8 months. In patients with negative EGFR, median RFS and OS were not yet reached. Her 2 positive patients had median RFS of 19.2 months compared to 63.8 months in Her-2 negative patients. Her-2 negative patients had median OS of 59.7 months while median was not reached in Her 2 positive patients. Conclusions: While the differences are not statistically significant, the trends observed warrant prospective investigation of the prognostic significance of these markers in a larger population of muscle invasive bladder cancer patients. No significant financial relationships to disclose.

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The Role of Partial Cystectomy in the Treatment of Muscle-Invasive Bladder Cancer

Urologia Journal ◽

10.1177/039156030507200202 ◽

2005 ◽

Vol 72 (2) ◽

pp. 215-223

Author(s):

P. Tombolini ◽

M. Ruoppolo ◽

G. Dormia ◽

E. Dormia

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Disease Free Survival ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Bladder Preservation ◽

Free Survival ◽

Muscle Invasive ◽

Bladder Sparing ◽

Disease Free

Partial cystectomy has been widely performed in the treatment of muscle-invasive bladder cancer in the 1960s and 70s. During the 1970s and 80s a more aggressive surgical approach was advocated by urologists. However, major complications occurred in 4–25% of patients undergoing radical cystectomy and urinary diversion. The overall survival in patients managed by radical cystectomy has increased during the last decades, but disease-free survival remains the same. This procedure allows excellent loco-regional tumor control, but not changes in the timing of distant metastases and in the failure to control the disease. Recently, multimodal strategies in sparing bladder surgery have been proposed. Neoadjuvant chemotherapy, with or without irradiation, allows bladder sparing surgery in selected patients. A literature review demonstrates a later recurrence in the preserved bladder ranging from 40–75%. One-third of these recurrences required cystectomy and 15–20% of cases with bladder preservation experienced disease progression and died of cancer within 2 yrs. Only 40 and 20% of T2-T3 bladder cancer patients are alive and disease-free at 5 and 10 yrs of follow-up, respectively. In our experience, in selected patients, disease-free survival, overall survival, time to progression and final bladder preservation rate was higher compared to other patients. Bladder sparing in selected patients, i.e. single non-recurrent neoplasm, favorable site, no prostatic or urethral involvement, complete response to neoadjuvant chemotherapy, no P53 overexpression, no previous BCG-failure, is a feasible approach. Cystectomy, possibly with neobladder tailoring, is currently, the standard therapy for muscle-invasive bladder cancer. A better understanding of bladder tumor disease is necessary to choose the optimal treatment and to control each individual patient.

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