scholarly journals OUTCOME OF PATIENTS TREATED WITH BLADDER PRESERVATION PROTOCOL IN UROTHELIAL CARCINOMA OF URINARY BLADDER

2021 ◽  
Vol 71 (6) ◽  
pp. 2118-21
Author(s):  
Sameed Hussain ◽  
Abdus Samad Syed ◽  
Fouzia Abdus Samad
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Concurrent Chemoradiotherapy ◽  
Complete Response ◽  
Military Hospital ◽  
Bladder Preservation ◽  
Alternative Approach ◽  
Muscle Invasive ◽  
Trimodality Treatment

Objective: To explore trimodality treatment with neoadjuvant chemotherapy followed by concurrent chemoradiotherapy as an alternative approach to neoadjuvant chemotherapy followed by radical cystectomy, for the treatment of non-metastatic muscle invasive bladder carcinoma. Study Design: Retrospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi Pakistan, from 2006 and 2015. Methodology: A total of 122 patients were evaluated in a retrospective manner. Primary endpoint was overall survival. Patients received four courses of neoadjuvant chemotherapy followed by radical concurrent chemoradiotherapy with Cisplatin as radiation sensitizer. Result: 5-year overall survival was 80 (66%) in this population and a complete response following completion of treatment was seen in 93 (76.3%) patients. Subset analysis showed markedly increased 5-year overall survival of around 104 (85%) in patients having complete response after neoadjuvant chemotherapy. Conclusion: The study concludes that bladder preservation is an acceptable alternative to radical cystectomy in selected population especially among those who had a complete response to the initial four courses of chemotherapy.

scholarly journals Bladder Preservation with Neoadjuvant Chemotherapy Followed by Concurrent Chemoradiation for the Treatment of Muscle-invasive Carcinoma of the Bladder: A Single-Center Experience

2020 ◽  
Vol 09 (03) ◽  
pp. 121-125
Author(s):  
Chinmayee Agrawal ◽  
Saurabh Bansal ◽  
Manoj Biswas ◽  
Meenu Gupta ◽  
Vipul Nautiyal ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Partial Response ◽  
Radical Cystectomy ◽  
Invasive Carcinoma ◽  
Residual Disease ◽  
Response Assessment ◽  
Complete Response ◽  
Concurrent Chemoradiation ◽  
Bladder Preservation ◽  
Muscle Invasive

Abstract Purpose The purpose of the study was to evaluate the short-term response and acute toxicities in muscle-invasive carcinoma urinary bladder treated with neoadjuvant chemotherapy followed by concurrent chemoradiation. Materials and Methods Thirty patients with muscle-invasive bladder cancer were treated with three cycles of neoadjuvant chemotherapy every 3 weeks. Response assessment was done after 4 weeks with repeat cystoscopy and imaging. Responders were treated with concurrent chemoradiation 60 Gy/30# at 2 Gy/# along with weekly injection cisplatin 35 mg/m2. Response assessment was done by new response evaluation criteria in solid tumors (version 1.1). Treatment-related acute toxicities were scored using common terminology criteria for adverse events version 4.0. Results Of the 30 patients, 25 patients responded to neoadjuvant chemotherapy with complete response in 17 patients (56.67%) and partial response in eight patients (26.66%). Five patients (16.66%) showed poor response and were advised radical cystectomy, of which four underwent radical cystectomy and one patient opted for concurrent chemoradiation. Of 26 patients who completed chemoradiation, complete response was seen in 21 patients (80.76%) and partial response was seen in four patients (15.38%). Only one patient developed progression of disease in the form of lung metastasis. All the patients with residual disease were advised to undergo salvage cystectomy. Among the patients receiving chemoradiation, grade 2 cystitis and diarrhea was seen in 10 patients (38.46%) and four patients (15.38%), respectively. Only one patient developed grade 3 diarrhea. Conclusion Bladder preservation treatment is an effective, safe, and convenient option for patients presenting with muscle-invasive carcinoma bladder. Neoadjuvant chemotherapy followed by chemoradiation was well-tolerated with an acceptable rate of complications.

scholarly journals Meta-analysis of neoadjuvant chemotherapy compared to radical cystectomy alone in improving overall survival of muscle-invasive bladder cancer patients

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Agus Rizal A. H. Hamid ◽  
Fanny Riana Ridwan ◽  
Dyandra Parikesit ◽  
Fina Widia ◽  
Chaidir Arif Mochtar ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Meta Analysis ◽  
Total Sample ◽  
Invasive Bladder Cancer ◽  
Forest Plot ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Abstract Background Most patients with muscle-invasive bladder cancer (MIBC) developed metastasis within 2 years, even after radical cystectomy (RC). The recurrence rate of MIBC was more than 50% of the cases. A meta-analysis conducted by Yin et al. showed that neoadjuvant chemotherapy (NAC) + RC improves overall survival in MIBC compared with RC only. However, a new meta-analysis by Li et al. concluded that NAC + RC was not superior to RC only in improving overall survival. The inconsistencies of these studies required further comprehensive analysis to recommend NAC use in bladder cancer treatment. Therefore, this meta-analysis aims to analyze previous studies that compare the efficacy of NAC + RC versus RC only to improve overall survival of MIBC. Methods The articles were searched using Pubmed with keywords “muscle-invasive bladder cancer”, “neoadjuvant chemotherapy”, “cystectomy”, and “overall survival”. The articles that were published until June 2020 were screened. The overall survival outcome was analyzed as hazard ratio (HR) and presented in a forest plot. Result Seventeen studies were included in meta-analysis with a total sample of 13,391 patients, consist of 2890 received NAC followed by RC and 10,418 underwent RC only. Two studies used methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), two studies used gemcitabine/cisplatin (GC), one study used Cisplatin-based regimen, one study used MVAC or GC, one study used gemcitabine/carboplatin (GCarbo) or GC or MVAC, one study used Cisplatin/Gemcitabine or MVAC, one study used Cisplatin only, one study used Cisplatin-based (GC, MVAC) or non-Cisplatin-based (combined paclitaxel/gemcitabine/carboplatin), one study used GC, MVAC, Carboplatin, or Gemcitabine/Nedaplatin (GN), and five studies did not mention the regimen The overall survival in the NAC + RC only group was significantly better than the RC only group (HR 0.82 [0.71–0.95], p = 0.009). Conclusion NAC + RC is recommended to improve overall survival in MIBC patients. A further study assessing side effects and quality of life regarding NAC + RC is needed to establish a strong recommendation regarding this therapy.

The effect of neoadjuvant chemotherapy on pathologic downstaging and survival for patients with muscle-invasive bladder cancer with mixed histological features.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15019-e15019
Author(s):  
James Lin ◽  
Dara Denise Holder ◽  
Michael Whalen ◽  
Gregory Hruby ◽  
Guarionex DeCastro ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Clinical Stage ◽  
Histological Type ◽  
Histological Features ◽  
Final Pathology ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive

e15019 Background: Urothelial carcinoma of the bladder (UCB) with mixed histological features (MH) is thought to portend a worse prognosis when compared to pure UC, based on reports of decreased survival for pure non-UC tumors. While patients with muscle-invasive UCB have been shown to derive a survival benefit from treatment with neoadjuvant chemotherapy (NC), the response of patients with MH is unclear. We sought to examine the pathologic and clinical outcomes of treatment with NC of patients with MH versus those with pure UC. Methods: Between 1990-2011, 318 patients were identified with clinical stage T2-T4a, N0-Nx, M0-Mx UCB who had either NC (+/- radical cystectomy) (n=67) or radical cystectomy (RC) alone (n=251). Among those given NC, 58% received methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) and 24% received gemcitabine/cisplatin. 265 patients had pure UC and 53 patients had MH, defined as UC with concomitant squamous or glandular differentiation on final pathology (biopsy histology used if pT0 or RC not performed). Endpoints included downstaging to pT0 and overall survival. Multivariable Cox regression was used to estimate the effect of histological type (MH vs. pure UC) on all-cause mortality within each treatment arm (NC vs. RC only) and to test for treatment-by-histological type interaction. Results: The rate of downstaging to pT0 was significantly higher in NC treated patients (34.3%) compared to those with RC alone (4.4%, p<0.01). When stratified by histology, downstaging to pT0 was not significantly different for those treated with NC (37.0% for pure UC vs. 23.1% for MH, p=0.34). After adjusting for age, pathologic stage, and positive surgical margins on multivariate Cox regression, there was no difference in survival outcome for those with MH vs. pure UC (HR=1.5, p=0.5), nor for those treated with NC vs. RC only (HR=2.8, p=0.1). Conclusions: Prior evidence on the benefits of NC for patients with MH is mixed, but our data suggest that there is improvement in rate of pT0 on final pathology in those treated with NC, regardless of histology. As NC is not detrimental to the overall survival of MH patients, its administration should be continued.

Selective organ preservation with neoadjuvant chemotherapy in the treatment of muscle invasive transitional cell carcinoma (TCC) of the bladder.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 310-310
Author(s):  
Shaista Hafeez ◽  
Robert Anthony Huddart
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Partial Response ◽  
Poor Response ◽  
Complete Response ◽  
Radical Radiotherapy ◽  
Bladder Preservation ◽  
Platinum Based Chemotherapy ◽  
Muscle Invasive

310 Background: Radiotherapy has been previously associated with high treatment failure for those with muscle invasive bladder cancer. Evidence suggests modern organ sparing approaches may have favourable outcome in appropriately selected patients. We investigate whether response to neo-adjuvant chemotherapy can guide selection for bladder preservation and identify those patients likely to have greater success with radical radiotherapy treatment. Methods: Retrospective analysis of 94 patients with T2-T4aN0M0 bladder TCC treated between January 2000 and June 2011. Patients received platinum based chemotherapy following transuretheral resection of bladder tumour, with repeat cystoscopy (+biopsy) performed to guide subsequent management. Poor responders were advised to proceed with surgery. We report on the outcome of 79 individuals who received radiotherapy. Results: 56 (60%) patients achieved complete response following chemotherapy (72% with stage T2). 15 (16%) patients achieved partial pathological response. 12 patients had radiological assessment of partial response made. 11 patients had poor response. All patients achieving complete response, 22 with partial response and 1 with poor response proceeded to radical radiotherapy. Median time to disease progression following radiotherapy was 17months (range 8-91). 5 patients developed invasive recurrence, 17 developed superficial recurrence, 4 developed local nodal disease and 7 developed metastasises. After median follow-up of 36 months (range 6-114), 50 patients were alive with no disease, 24 had died (14 from metastatic bladder cancer and 10 from other causes). 5 patients were alive with active disease (4 with localized and 1 with metastatic disease). 13 required cystectomy (9 for superficial disease, 3 for invasive recurrence, and 1 for treatment related toxicity). Of those alive and disease free 84% had an intact bladder. 82% had an intact bladder at last follow-up or death. Conclusions: Neoadjuvant chemotherapy followed by radical radiotherapy allows bladder preservation in over 80% of selected patients with survival rates comparable to contemporary surgical series.

Identifying predictors of pathologic complete response to neoadjuvant chemotherapy for muscle invasive bladder cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16015-e16015
Author(s):  
Andrea Harzstark ◽  
Maqdooda Merchant
Keyword(s):  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Bivariate Analysis ◽  
Limited Information ◽  
Split Dose ◽  
Muscle Invasive

e16015 Background: Pathologic complete response (pCR) to neoadjuvant chemotherapy is associated with improved outcome in patients (pts) with muscle invasive and/or lymph node positive (LN+) bladder cancer. Although molecular predictors are currently being evaluated, limited information is available regarding purely clinical parameters offering predictive information regarding pCR to neoadjuvant chemotherapy. Methods: We identified 189 unique pts within Kaiser Permanente Northern California diagnosed with bladder cancer during 1/1/10 through 12/31/17 who underwent chemotherapy with neoadjuvant intent with a plan for subsequent radical cystectomy. All pts had disease that was ≥cT2 and/or ≥cN1 and M0. Fourteen variables were examined for their association with pCR at radical cystectomy, using bivariate analysis and multivariate models. Results: Of the 189 pts in our cohort, 141 (74.6%) were male, 162 (85.7%) were white and the mean age was 66.4 years. 76 (40.2%) pts achieved pCR; of these, 59 (77.6%) had pre-treatment hemoglobin (hg) ≥ 13 g/dL (p = 0.0087), 69 (90.8%) did not have hydronephrosis (p < 0.0001), 66 (86.8%) had no lymphovascular invasion (LVI) on transurethral resection of bladder tumor (TURBT) (p = 0.0506) and 69 (90.8%) had cT2 disease at time of diagnosis (p < 0.0001). Logistic regression analysis showed that pCR was associated with hg ≥ 13 (OR 2.736, 95% CI 1.188-6.657), absence of hydronephrosis (OR 4.672, 95% CI 1.820-13.554), age ≤ 75 years (OR 3.410, 95% CI 1.263-10.057), absence of LVI on TURBT (OR 2.592, 95% CI 1.055-6.829), and clinical stage T2 vs. ≥T3 and/or N+ (OR 6.480, 95% CI 2.645-17.858). There was no statistically significant relationship between pCR and the following variables: cumulative cisplatin dose, split dose chemotherapy, chemotherapy regimen, history of tobacco use, race, gender, Charlson comorbidity score, baseline alkaline phosphatase, and percentage body weight loss during therapy. Conclusions: Pathologic CR was predicted by Hg < 13 g/dL, absence of hydronephrosis, age ≤ 75 yrs, absence of LVI on TURBT specimen, and stage at diagnosis. These factors may influence selection of pts with muscle invasive and/or LN+ bladder cancer for neoadjuvant chemotherapy.

scholarly journals Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Matteo Ferro ◽  
Ottavio de Cobelli ◽  
Gennaro Musi ◽  
Giuseppe Lucarelli ◽  
Daniela Terracciano ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Retrospective Study ◽  
Radical Cystectomy ◽  
Univariate Analysis ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Muscle Invasive Bladder Cancer ◽  
Time To Recurrence ◽  
Muscle Invasive

BackgroundThree or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes.MethodsPatients with histologically confirmed muscle-invasive UBC included in this retrospective study had to be treated with either 3 (cohort A) or 4 (cohort B) cycles of cisplatin-gemcitabine as neoadjuvant therapy before undergoing radical cystectomy with lymphadenectomy. Outcomes including pathologic downstaging to non-muscle invasive disease, pathologic complete response (defined as absence of disease -ypT0), overall- and cancer-specific- survival as well as time to recurrence were compared between cohorts A vs. B.ResultsA total of 219 patients treated at 14 different high-volume Institutions were included in this retrospective study. Patients who received 3 (cohort A) vs. 4 (cohort B) cycles of neoadjuvant cisplatin-gemcitabine were 160 (73,1%) vs. 59 (26,9%).At univariate analysis, the number of neoadjuvant cycles was not associated with either pathologic complete response, pathologic downstaging, time to recurrence, cancer specific, and overall survival. Of note, patients in cohort B vs. A showed a worse non-cancer specific overall survival at univariate analysis (HR= 2.53; 95 CI= 1.05 - 6.10; p=0.046), although this finding was not confirmed at multivariate analysis.ConclusionsOur findings suggest that 3 cycles of cisplatin-gemcitabine may be equally effective, with less long-term toxicity, compared to 4 cycles in the neoadjuvant setting.

scholarly journals Prediction of pathological response following neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer: the PRE-PREVENCYS trial

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
F. J. Hinsenveld ◽  
B. J. Noordman ◽  
J. L. Boormans ◽  
J. Voortman ◽  
G. J. L. H. van Leenders ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Controlled Trial ◽  
Complete Response ◽  
Pathological Response ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Abstract Background The recommended treatment for patients with non-metastatic muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Following NAC, 20–40% of patients experience a complete pathological response (pCR) in the RC specimen and these patients have excellent long-term overall survival. Subject to debate is, however, whether patients with a pCR to NAC benefit from RC, which is a major surgical procedure with substantial morbidity, and if these patients might be candidates for close surveillance instead. However, currently it is not possible to accurately identify patients with a pCR to NAC in whom RC might be withheld. The objective of this study is to assess whether pathological response in the RC specimen after NAC can be predicted based on clinical, radiological, and histological variables and on a wide set of molecular biomarkers assessed in tissue, blood and urine. Methods This is a multicentre, prospective cohort study, including patients with cT2a-T4a N0-N1 M0 urothelial cell MIBC who are scheduled to undergo cisplatin-based NAC followed by RC. Prior to start of therapy, a 2-Deoxy-2-[18F] fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is performed. Response to NAC is evaluated by CT-scan. Blood and urine, including cytology, are prospectively collected for biomarker analyses before and after NAC. Immediately before RC, participants undergo cystoscopy with bimanual examination and a re-staging transurethral resection (TUR) of all visible cancerous lesions or with biopsies from scar tissue. Subsequently, RC is performed in all patients. Tissue from the diagnostic TUR, the re-staging TUR, and the RC specimen is examined for the presence of urothelial cancer carcinoma and DNA and RNA is isolated for molecular analysis. The primary endpoint is the pathological stage (ypTN) in the RC and ePLND specimen and its association with clinical response. Discussion If the PRE-PREVENCYS trial shows that the absence of residual disease after NAC in patients with MIBC is accurately predicted, a randomized controlled trial is scheduled comparing the overall survival of NAC plus RC versus NAC followed by close surveillance for patients with a clinically complete response (PREVENCYS trial). Trial registration Netherlands Trial Register: NL8678; Registered 20 May 2020 https://www.trialregister.nl/trial/8678

Neoadjuvant cisplatin/gemcitabine chemotherapy for muscle invasive bladder carcinoma: A single institution experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15016-e15016
Author(s):  
Roshni Deepa Kalachand ◽  
Felicity McDonnell ◽  
Deaglan McHugh ◽  
Raymond McDermott
Keyword(s):  
Overall Survival ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Performance Status ◽  
Transitional Cell ◽  
Neoadjuvant Treatment ◽  
Disease Free Survival ◽  
Complete Response ◽  
Comparable Efficacy ◽  
Muscle Invasive

e15016 Background: Neoadjuvant chemotherapy (NAC) with MVAC has been shown to improve overall survival in patients with muscle invasive transitional cell carcinoma of the bladder (MIBC), with pathological complete response (pCR) correlating with a survival benefit. Despite the lack of randomized data for cisplatin/gemcitabine (GC) in the neoadjuvant setting, it is commonly used in clinical practice, given its favorable toxicity profile and comparable efficacy to MVAC in the context of metastatic disease. Methods: Data was retrospectively obtained on 93 patients with T2-T4, N0-2 M0 MIBC treated with curative intent in our institution between 2005-2011. Characteristics of patients treated with GC NAC, along with treatment tolerance and outcomes, were collected. Results: Of 93 patients, 27% (n=25) were treated with GC NAC. Median age was 66 (range 49-81). 88% (n=22) of patients were clinical stage T3/4 and/or N1/2. 68% of patients received 28-day cycles of GC, with 32% receiving 21-day cycles of GC. One patient had split cisplatin dosing. 91% and 82% of planned cisplatin and gemcitabine were delivered, respectively. There were no treatment-related deaths. On completion of NAC, 52% (n=13) of patients underwent radical cystectomy, of whom 38% (n=5) achieved a pCR, and 62% (n=8) were downstaged to non-muscle invasive bladder cancer (nMIBC). Definitive chemoradiotherapy was used in 20% (n=5) of patients, whilst 12% (n=3) had no radical treatment due to progressive disease (n=2), or to a decline in ECOG performance status (n=1). Amongst patients without radical cystectomy, 12% (n=3) of patients achieved a biopsy-proven clinical complete response (cCR). In the intent-to-treat population, median disease-free survival was 32 months, and median overall survival 38.8 months. All patients with a pCR, cCR, or downstaging to nMIBC (n=12), were alive at a median follow-up of 16 months (3.9 – 49.1 months), although 1 patient had relapsed. Conclusions: GC is a well-tolerated regimen in the neoadjuvant treatment of MIBC, with a pCR rate comparable to that reported with MVAC. Our findings support the use of GC in the neoadjuvant treatment of MIBC.

Sign in / Sign up

Export Citation Format

Share Document