Abstract:

Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle-invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin-based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin-based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty-nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin-based chemotherapy (n = 25), carboplatin-based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five-year event-free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression-free survival, and 30 (SE = 8) for cancer-specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5-year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit-for-cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Notes:

Export Date: 18 February 2017References: Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data Advanced Bladder Cancer (ABC) Meta-Analysis Collaboration (2005) Eur. Urol., 48, pp. 202-205;Fedeli, U., Fedewa, S.A., Ward, E.M., Treatment of muscle invasive bladder cancer: evidence from the National Cancer Database, 2003 to 2007 (2011) J. Urol., 185, pp. 72-78; Efstathiou, J.A., Spiegel, D.Y., Shipley, W.U., Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience (2012) Eur. Urol., 61, pp. 705-711; Rodel, C., Grabenbauer, G.G., Kuhn, R., Papadopoulos, T., Durst, J., Meyer, M., Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results (2002) J. Clin. Oncol., 20, pp. 3061-3071; Dodd, P.M., McCaffrey, J.A., Herr, H., Mazumdar, M., Bacik, J., Higgins, G., Outcome of postchemotherapy surgery after treatment with methotrexate, vinblastine, doxorubicin, and cisplatin in patients with unresectable or metastatic transitional cell carcinoma (1999) J. Clin. Oncol., 17, pp. 2546-2552; Bournakis, E., Dimopoulos, M.A., Bamias, A., Management of advanced bladder cancer in patients with impaired renal function (2011) Expert Rev. Anticancer Ther., 11, pp. 931-939; Canter, D., Viterbo, R., Kutikov, A., Wong, Y.N., Plimack, E., Zhu, F., Baseline renal function status limits patient eligibility to receive perioperative chemotherapy for invasive bladder cancer and is minimally affected by radical cystectomy (2011) Urology, 77, pp. 160-165; Gray, P., Fedewa, S., Shipley, W., Efstathiou, J., Lin, C.C., Zietman, A., Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Database (2013) Eur. Urol., 63, pp. 823-829; Hindson, B.R., Turner, S.L., Millar, J.L., Foroudi, F., Gogna, N.K., Skala, M., Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder (2012) J. Med. Imaging Radiat. Oncol., 56, pp. 18-30; Donato, V., Valeriani, M., Zurlo, A., Short course radiation therapy for elderly cancer patients. Evidences from the literature review (2003) Crit. Rev. Oncol. Hematol., 45, pp. 305-311; Koie, T., Ohyama, C., Hashimoto, Y., Hatakeyama, S., Yamamoto, H., Yoneyama, T., Efficacies and safety of neoadjuvant gemcitabine plus carboplatin followed by immediate cystectomy in patients with muscle-invasive bladder cancer, including those unfit for cisplatin: a prospective single-arm study (2013) Int. J. Clin. Oncol., 18, pp. 724-730; Galsky, M.D., Hahn, N.M., Rosenberg, J., Sonpavde, G., Hutson, T., Oh, W.K., A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy (2011) J. Clin. Oncol., 29, pp. 2432-2438; (2013) Common Terminology Criteria for Adverse Events v4.0 (CTCAE), , http://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/..., (accessed 2 December 2013); Cox, J.D., Stetz, J.,., Pajak, T.F.,., Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) (1995) Int. J. Radiat. Oncol. Biol. Phys., 31, pp. 1341-1346; Bamias, A., Moulopoulos, L.A., Koutras, A., Aravantinos, G., Fountzilas, G., Pectasides, D., The combination of gemcitabine and carboplatin as first-line treatment in patients with advanced urothelial carcinoma. A Phase II study of the Hellenic Cooperative Oncology Group (2006) Cancer, 106, pp. 297-303; De Santis, M., Bellmunt, J., Mead, G., Kerst, J.M., Leahy, M., Maroto, P., Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986 (2012) J. Clin. Oncol., 30, pp. 191-199; Zouhair, A., Ozsahin, M., Schneider, D., Bauer, J., Jichlinski, P., Roth, A., Invasive bladder carcinoma: a pilot study of conservative treatment with accelerated radiotherapy and concomitant cisplatin (2001) Int. J. Cancer, 96, pp. 350-355; Bamias, A., Efstathiou, E., Moulopoulos, L.A., Gika, D., Hamilos, G., Zorzou, M.P., The outcome of elderly patients with advanced urothelial carcinoma after platinum-based combination chemotherapy (2005) Ann. Oncol., 16, pp. 307-313; Bellmunt, J., Choueiri, T.K., Fougeray, R., Schutz, F.A., Salhi, Y., Winquist, E., Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens (2010) J. Clin. Oncol., 28, pp. 1850-1855; Chung, P.W.M., Bristow, R.G., Milosevic, M.F., Yi, A.L., Jewett, M.A.S., Warde, P.R., Long-term outcome of radiation-based conservation therapy for invasive bladder cancer (2007) Urol. Oncol., 25, pp. 303-309; Mitin, T., Hunt, D., Shipley, W.U., Kaufman, D.S., Uzzo, R., Wu, C.L., Transurethral surgery and twice-daily radiation plus paclitaxel-cisplatin or fluorouracil-cisplatin with selective bladder preservation and adjuvant chemotherapy for patients with muscle invasive bladder cancer (RTOG 0233): a randomised multicentre phase 2 trial (2013) Lancet Oncol., 14, pp. 863-872; James, N.D., Hussain, S.A., Hall, E., Jenkins, P., Tremlett, J., Rawlings, C., Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer (2012) N. Engl. J. Med., 366, pp. 1477-1488; Sammon, J.D., Pucheril, D., Abdolalah, F., Varda, B., Sood, A., Bhojani, N., Preventable mortality after common urological surgery: failing to rescue? (2015) BJU Int., 115, pp. 666-674; Herr, H.W., Outcome of patients who refuse cystectomy after receiving neoadjuvant chemotherapy for muscle-invasive bladder cancer (2008) Eur. Urol., 54, pp. 126-132; De Santis, M., Bachner, M., Cerveny, M., Kametriser, G., Steininger, T., Königsberg, R., Combined chemoradiotherapy with gemcitabine in patients with locally advanced inoperable transitional cell carcinoma of the urinary bladder and/or in patients ineligible for surgery: a phase I trial (2014) Ann. Oncol., 25, pp. 1789-1794; Turgeon, G.A., Souhami, L., Cury, F.L., Faria, S.L., Duclos, M., Sturgeon, J., Hypofractionated intensity modulated radiation therapy in combined modality treatment for bladder preservation in elderly patients with invasive bladder cancer (2014) Int. J. Radiat. Oncol. Biol. Phys., 88, pp. 326-331; deVere, R., Lara, P., Jr., Goldman, B., Tangen, C., Smith, D., Wood, D., Jr., A sequential treatment approach to myoinvasive urothelial cancer: a phase II Southwest Oncology Group Trial (S0219) (2009) J. Urol., 81, pp. 2476-2481

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