scholarly journals Improving the outcome of patients with muscle invasive urothelial carcinoma of the bladder with neoadjuvant gemcitabine/cisplatin chemotherapy: A single institution experience

2014 ◽  
Vol 8 (3-4) ◽  
pp. 287 ◽  
Author(s):  
Faraj El-Gehani ◽  
Scott North ◽  
Sunita Ghosh ◽  
Peter Venner
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Clinical Stage ◽  
Retrospective Chart Review ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Lower Stage ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive ◽  
Gemcitabine And Cisplatin

Introduction: Neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle invasive urothelial carcinoma of the bladder improves survival. This study was undertaken to determine the rate of neoadjuvant gemcitabine and cisplatin use prior to RC and to assess its effect on the pathologic response rates and cancer-specific survival (CSS) and overall survival (OS).Methods: This retrospective chart review examined all patients having a RC between January 1, 2007 and June 30, 2011. We collected patient demographics, pre-treatment clinical stage, type of chemotherapy, post-RC pathologic data and survival data.Results: A total of 251 RC were performed of which 160 were for stage cT2-T4 urothelial carcinoma of the bladder. Of the 160 patients, 91 (57%) received neoadjuvant gemcitabine and cisplatin (GC) and 69 (43%) went straight to RC. Patients receiving neoadjuvant GC had a greater chance of achieving a pathologically lower stage compared to the untreated population: pT0 at 21% vs. 3%; non-invasive cancer at 37% vs. 10%; and organ-confined cancer at 60% vs. 33% (p < 0.001). Survival correlated with pathological stage: ≤pT3a patients had a median OS and CSS of 48.8 and 51.2 months compared to an OS and a CSS in ≥pT3b patients of 21.8 and 28.1 months, respectively (p < 0.0001).Conclusions: Neoadjuvant chemotherapy for urothelial carcinoma of the bladder is more frequently administered at our institution compared to the published literature. We have found that neoadjuvant chemotherapy increases the rate of down-staging, which is associated with a reduced the risk of death from urothelial carcinoma of the bladder.

Micropapillary urothelial carcinoma of the urinary bladder: Early surgery or neoadjuvant chemotherapy?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16007-e16007
Author(s):  
I. Ghoneim ◽  
A. Stephenson ◽  
M. Gong ◽  
S. Campbell ◽  
A. Fergany
Keyword(s):  
Lymph Node ◽  
Neoadjuvant Chemotherapy ◽  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Metastatic Lymph Node ◽  
Systemic Disease ◽  
Clinical Stage ◽  
Cancer Specific Survival ◽  
Extended Lymph Node Dissection

e16007 Background: Micropapillary bladder carcinoma is a rare variant of urothelial carcinoma (UC) of the urinary bladder. As a particularly aggressive variant, patients are often urged to undergo up-front radical cystectomy. Though data is scarce on the treatment outcomes of patients with this entity, we present the case for neoadjuvant chemotherapy as opposed to early cystectomy in the setting of clinically localized micropapillary UC. Methods: A review of records of all patients evaluated at our institution for UC was conducted to identify micropapillary UC of the bladder over the period from 2000–2007. A total of 24 cases were found, and were evaluated for preoperative pathology and clinical stage, treatment course, pathological stage and cancer specific survival. Results: Mean patient age was 67.9 years with 19 males and 5 females. Twenty-one (87.5%) patients had clinically organ confined micropapillary UC at the time of diagnosis, three had minimally enlarged lymph nodes on pelvic CAT scans. Half of our patients had BCG refractory high grade non-muscle invasive UC. Twenty-two patients (91.67%) were offered radical cystectomy as first line management. Extended lymph node dissection was performed in eleven patients (45.83%). Final pathologic examination diagnosed metastatic lymph node involvement in 20 patients (83.33%), with 4 patients (20%) having positive LN outside the standard (pelvic) template of dissection. A stage upgrade was noticed in 95.23% of cases. Median cancer specific survival was 13 months. Survival at one year was 44% and 50% at 2years, with only one patient alive at 5 years. Conclusions: Our results suggest that clinically localized micropapillary UC is often metastatic to LN at the time of presentation. This setting of frequent systemic disease should encourage standard neoadjuvant chemotherapy rather than early surgical management for these patients. Extended LN dissection is warranted in these cases due to the high incidence of nodal involvement outside the standard template. No significant financial relationships to disclose.

Neoadjuvant cisplatin/gemcitabine (CG) chemotherapy for muscle-invasive transitional cell carcinoma of the bladder (TCCB): A single-institution experience.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 304-304
Author(s):  
Scott A. North ◽  
Faraj El-Gehani ◽  
Peter Venner
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Clinical Stage ◽  
Transitional Cell ◽  
Neoadjuvant Treatment ◽  
Retrospective Chart Review ◽  
Pathologic Response ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pre Treatment ◽  
Muscle Invasive

304 Background: Despite evidence of a survival advantage for neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy (RC) for muscle-invasive TCCB, many patients are not treated. While many Canadian centers use CG chemotherapy in this setting, there is little data on pathologic response rate, often considered an important predictor of long term outcome. This retrospective study was undertaken to determine the use of neoadjuvant treatment prior to RC at our institution and assess pathologic response rates at time of RC for patients receiving neoadjuvant CG. Methods: A retrospective chart review was performed on all patients undergoing RC between January 1, 2007 and June 30, 2011 in Edmonton, Alberta, Canada. Data were collected on patient demographics, pre-treatment clinical stage information, type and amount of chemotherapy administered, and pathologic data from RC specimens. Results: A total of 251 RC were performed during the study period. Eighty-three RC were performed for non-muscle invasive TCC: 15 non-malignant causes, 27 refractory superficial TCC, 41 non-TCC malignant histology. A total of 168 RC were performed for T2-T4 TCC. Median age at diagnosis was 68 years. Ninety-two (55%) patients received neoadjuvant CG. Seventy-five (45%) patients went straight to RC. Reasons for neoadjuvant GC not being given include: medical contraindication in 43 patients (56%), patient refusal in 9 patients (12%) and lack of referral to Medical Oncologist in 24 patients (32%). Of a possible 116 patients who would have been eligible to receive neoadjuvant chemotherapy, 92/116 (79%) were treated. Of the 92 patients receiving chemotherapy prior to RC, 19 (21%) of the surgical specimens were pathologically free of cancer (pT0) at the time of surgery and 18 (20%) had only superficial disease remaining. By contrast, only three (4%) of the 75 patients who went to immediate RC achieved pT0 status and 5 (7%) had remaining superficial disease. Conclusions: The use of neoadjuvant chemotherapy prior to RC at our institution is higher than quoted in published literature. The use of neoadjuvant GC improves the chances of eliminating residual cancer in the RC specimen.

Pathologic response rates between gemcitabine-cisplatin (GC) and methotrexate, vinblastine, doxorubicin hydrochloride, and cisplatin (MVAC) neoadjuvant chemotherapy in muscle-invasive urothelial cell carcinoma of the bladder.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 267-267 ◽  
Author(s):  
Jonathan Lawrence Wright ◽  
Franklin Lee ◽  
William Proctor Harris ◽  
Heather H. Cheng ◽  
Song Zhao ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Cardiac Disease ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Pathologic Response ◽  
Bcg Therapy ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive

267 Background: Neoadjuvant chemotherapy for muscle invasive urothelial carcinoma (UC) of the bladder is associated with higher rates of pathologic complete response (CR) and improved disease-specific survival compared to those treated with radical cystectomy (RC) alone. Two standard regimens used are (1) gemcitabine and cisplatin (GC); and (2) methotrexate, vinblastine, adriamycin, and cisplatin (MVAC), with debate on whether there is a difference in clinical efficacy. In this analysis, we compare the pathologic outcomes at cystectomy between neoadjuvant GC and MVAC treatment. Methods: Data was retrospectively collected on patients with T2-T4 UC of the bladder who underwent RC between Sept 2003 and December 2011 at the University of Washington. Clinical and pathologic factors were recorded along with neoadjuvant chemotherapy and comorbidities. Pathologic outcomes included those with CR (pT0) and near CR (nCR = pT0/Ta/Tis). Odds ratio (OR) for CR and nCR were calculated using multivariate logistic regression adjusting for demographic (age, gender, race), medical (creatinine, diabetes mellitus, cardiac disease) and clinical factors (clinical T stage, prior BCG therapy, complete tumor debulking prior to chemotherapy). Results: A total of 78 patients received GC or MVAC neoadjuvant chemotherapy followed by RC, including 46 who received GC and 32 who received MVAC. There was no difference in gender, renal function, cardiac disease or clinical stage between the two groups. Patients over 70 years of age primarily received GC (17/18). CR was achieved in 30% and 25% (p = 0.15) of GC and MVAC patients, respectively (multivariate OR 0.42, 95% CI 0.11-1.63). nCR was more common in those receiving GC (50% vs. 38%, p = 0.04) although non-significant in the multivariate model (OR 0.30, 95% CI 0.07-1.16). Conclusions: We observed similar pathologic response rates for GC and MVAC neoadjuvant chemotherapy in this cohort of bladder cancer patients. These observations support the use of GC as an alternative regimen in the neoadjuvant setting.

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