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

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.

Trimodal bladder-preserving treatment including high-tech radiotherapy in invasive bladder carcinoma-dissertation project with literature review

Over the last two decades, there has been a significant evolution of the complex treatment of the invasive bladder carcinoma (BC), including both surgery methods and high-tech radiotherapy (RT), often combined with chemotherapy (Ch). Different protocols supporting multimodal treatment and the concept of the bladder preservation are currently developed. New high-tech radiation methods were presented combined with Ch to preserve the bladder as a healing alternative to radical cystectomy. The purpose of this overview is to present the place and healing effect of high-tech RT in the contemporary treatment approach to invasive BC. The expected contributions from this research project are: 1) For the first time in Bulgaria, modern bladder-sparing strategies combine maximal transurethral resection of bladder tumor (TURBT) followed by an induction course of concurrent radiation therapy (RT) and sensitizing chemotherapy will be held. 2) Disease-free survival, overall survival, local control and early radical toxicity in two patient groups after self intensity modulated radiation therapy (IMRT) and after concurrent chemoradiotherapy (CChRT) with VMAT will be analyzed. It is important to improve the quality of life by preserving the bladder in the invasive bladder carcinoma.

Partial Cystectomy Could Be a Better Option of Bladder Preservation in T1 High-Grade Bladder Cancer Patients: A Propensity Score Matching Study

Purpose: Partial cystectomy was investigated as a method of bladder preservation with better disease outcomes than transurethral bladder tumor resection in T1 high-grade bladder cancer patients.Method and materials: The national Surveillance, Epidemiology, and End Results database（SEER） (2004-2015) was used to obtain patients diagnosed with T1 high-grade bladder cancer, and finally, 25263 patients were enrolled in our study. The Kaplan-Meier method with the log-rank test was performed to analyze the outcome of overall survival (OS) and cancer-specific survival (CSS) between patients undergoing PC, TURBT, or RC. Moreover, the propensity score matching (PSM) and multivariable Cox proportional hazard model were also utilized in the study.Results: Ultimately, 24635 patients were undergoing TURBT, while 190 and 438 patients were respectively assigned to PC and RC groups. Compared with patients with TURBT, a tendency of a higher proportion of higher older and male patients was observed in the PC group. When matching with RC patients, patients in the PC group were common older and had bigger tumor sizes and single tumor. (All P<0.05). After 1:1 PSM, 190 patients with TURBT and 160 patients receiving RC were selected. In survival analysis, the patients in the PC group had a higher survival probability of both OS and CSS before and after PSM compared with those in the TURBT group. Meanwhile, no significant differences were observed between the RC and PC groups in OS and CSS analysis. Moreover, multivariable cox regression showed that PC was a protective factor for overall mortality (OM) and cancer-specific mortality (CSM) compared with TURBT in T1 high-grade patients. (All P<0.05)Conclusion: Patients undergoing partial cystectomy were shown to have a better outcome compared to those with transurethral bladder tumor resection in T1 high-grade bladder cancer patients. Partial cystectomy was a worthwhile alternative for T1 high-grade bladder cancer.

Survival Impact of Current-Smoking-Related COPD or COPD with Acute Exacerbation on Bladder Preservation through Concurrent Chemoradiotherapy for Muscle-Invasive Bladder Urothelial Carcinoma

PURPOSE: The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving concurrent chemoradiotherapy (CCRT) for bladder preservation is unclear. METHODS: We recruited patients with MIBUC, clinical stages IIA–IVB, who had received maximal transurethral resection of bladder tumor (TURBT) followed by CCRT from the Taiwan Cancer Registry Database. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on the preexisting COPD status (within 1 year before CCRT) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD). RESULTS: In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) of all-cause mortality in Group 2 compared with Group 1 was 1.89 (1.12–3.18), p = 0.017. The aHRs (95% CIs) of all-cause mortality for ≥1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT for bladder preservation were 3.26 (1.95–5.46) and 6.33 (3.55–11.281) compared with non-COPDAE patients with MIBUC undergoing CCRT for bladder preservation. CONCLUSION: Among patients with MIBUC undergoing TURBT followed by CCRT for bladder preservation, current smokers with smoking-related COPD had worse survival outcomes than did nonsmokers without COPD. Condensed Abstract: This was the first study to estimate the survival impact of smoking-related chronic obstructive pulmonary disease (COPD) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiotherapy (CCRT) for bladder preservation. Smoking-related COPD was a significant independent risk factor for all-cause mortality in patients with clinical stages IIA–IVB receiving TURBT followed by CCRT. Hospitalization frequency for COPD with at least one acute exacerbation within 1 year before CCRT was highly associated with high mortality for patients with MIBUC receiving CCRT for bladder preservation. Not only all-cause death but also bladder cancer death and COPD death were significantly higher in the current-smoking COPD group than in the never-smoking non-COPD group.

Holmium laser-assisted laparoscopic partial cystectomy for bladder cancer: technical feasibility and outcome

BackgroundIn selected patients with bladder cancer, partial cystectomy is an alternative treatment for bladder preservation with fair oncologic result. During partial cystectomy, tumor margin demarcation is difficult. Various methods were introduced, however, there is no standard for tumor margin demarcation. We aimed to introduce and provide our experience with holmium laser-assisted method with ten patients.MethodsFrom March 2016 and February 2019, patients who want partial cystectomy for bladder cancer were enrolled in this study. Inclusion criteria were stage T2 or T3 disease and tumor location restricted within the dome, and lateral, posterior side of the bladder were included. Transurethral holmium laser-assisted mucosal incision was made and deepened until perivesical fat. Minimal Safety margin for 5–10 mm were spared, and tumor removal was done laparoscopically.ResultsTen patients underwent holmium laser-assisted laparoscopic partial cystectomy. All procedures were done without complication. The tumor locations were laterally in seven patients, dome in two patients, and posterior wall in one patient. Pathologic examination of surgical margin showed no cancer cell involvement in all cases. There were no recurrences or metastases for 12 months follow up.ConclusionsHolmium laser-assisted laparoscopic partial cystectomy is effective and safe technique. To achieve precise and appropriate surgical margin during the laparoscopic partial cystectomy, holmium laser resection provides feasible and safe method that assists in bladder incision with minimal ureteral orifice involvement.Trial registrationRetrospectively registered.

A Muscle-Invasive Bladder Cancer Patient With High Tumor Mutational Burden and RB1 Mutation Achieved Bladder Preservation Following Chemotherapy Combined With Immunotherapy: A Case Report

Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for patients diagnosed with muscle-invasive bladder cancer (MIBC). However, urinary diversion following radical cystectomy significantly reduces patient quality of life. In addition, patients who significantly respond to neoadjuvant chemotherapy have a strong will to preserve the bladder. Bladder-sparing therapy has become a research focus worldwide. Although the bladder-sparing regimen, referred to as trimodality therapy (TMT), has been accepted, the efficacy of immunotherapy combined with chemotherapy for bladder preservation in patients with MIBC has not yet been published. We describe the case of a 50-year-old male presented intermittent macrohematuria and was diagnosed with bladder urothelial carcinoma by diagnostic transurethral resection of bladder tumor (TURBt) with clinical stage IIIA (cT3bN0M0). A complete response was achieved after four courses of neoadjuvant chemotherapy combined with pembrolizumab. Then, we performed a second TURBt plus randomized biopsy by cystoscopy. The pathology indicated no tumor in the bladder. Adjuvant chemoradiotherapy and immunotherapy were subsequently performed. Imaging examinations, cystoscopy and urine tumor DNA (utDNA) levels were used for surveillance after treatment. Finally, the patient achieved bladder preservation and had remained cancer-free for 19 months at the last follow-up on February 20, 2021. This is the first published case study to describe neoadjuvant chemotherapy plus pembrolizumab followed by concurrent chemoradiotherapy as a novel bladder-sparing regimen and successfully achieved a promising outcome.