DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20205656

Clinical outcome of muscle invasive carcinoma urinary bladder patients treated with bladder preservation protocol

John Joseph, Aswin Kumar, Susan Mathews, Jagathnath K. M. Krishna, Francis V. James

Abstract


Background: To evaluate the outcome in terms of bladder preservation in muscle invasive urinary bladder patients treated with radical radiotherapy.

Methods: A total of sixty patients with muscle invasive bladder cancer who were treated between 2011 and 2013 with bladder preservation protocol were identified. Thirty-two patients were stage T2 disease, rest were T3 and T4. Initial TURBT was reported complete in 24 of the total 60 patients. All patients received 60 to 64Gy to the whole bladder.

Results: The follow-up range was 3 to 72 months. One year follow-up proportion was 78%. The median progression free survival was 40months. Early stage (T2) and advanced stage (T3 and T4) had progression free survival of 87.8% and 48.5% respectively at one year follow-up with a p value of 0.001. Thirty-six patients who had an incomplete Transurethral resection of bladder tumor (TURBT) initially had a statistically significant lower PFS compared to those patients who had a complete TURBT with a p value of 0.029. Twenty-nine patients were disease free with an intact bladder during the follow-up period providing a bladder preservation rate of 48%.

Conclusions: A bladder-conserving protocol with radiotherapy provides encouraging results with nearly half of the patients able to retain a disease-free bladder. Proper patient selection with early stage disease and those with complete TURBT may further improve the bladder preservation rates.


Keywords


Muscle invasive bladder cancer, Bladder preservation, Radiotherapy

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References


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre L A, Jemal A. Global cancer statistics. GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394-424.

Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol. 2017;198:552-9.

Cooke PW, Dunn JA, Latief T, Bathers S, James ND, Wallace DM. Long-term risk of salvage cystectomy after radiotherapy for muscle-invasive bladder cancer. Eur Urol. 2000;38:279-86.

Perdona S, Autorino R, Damiano R, De Sio M, Morrica B, Gallo L, et al. Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer: a multi-institutional, long-term experience. Cancer. 2008;112:75-83.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Journal of the American Statistical Association. 1958;53:457-81.

Shelley MD, Barber J, Wilt T, Mason MD. Surgery versus radiotherapy for muscle invasive bladder cancer. Cochrane Database Syst Rev. 2002:CD002079.

Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349:859-66.

Madersbacher S, Hochreiter W, Burkhard F, Thalmann GN, Danuser H, Markwalder R, et al. Radical cystectomy for bladder cancer today-a homogeneous series without neoadjuvant therapy. J Clin Oncol. 2003;21:690-96.

Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19:666-75.

Kitamura H, Tsukamoto T, Shibata T, Masumori N, Fujimoto H, Hirao Y, et al. Urologic Oncology Study Group of the Japan Clinical Oncology Group. Randomised phase III study of neoadjuvant chemotherapy with methotrexate, doxorubicin, vinblastine and cisplatin followed by radical cystectomy compared with radical cystectomy alone for muscle-invasive bladder cancer: Japan Clinical Oncology Group Study JCOG0209. Ann Oncol. 2014;25:1192-98.

James ND, Hussain SA, Hall E, Jenkins P, Tremlett J, Rawlings C, et al. BC2001 Investigators. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366:1477-88.

Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Malek R, Kübler H, et al. Systematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol Semin Orig Investig. 2018;36:43-53.

Jiang DM, Chung P, Kulkarni GS, Sridhar SS. Trimodality Therapy for Muscle-Invasive Bladder Cancer: Recent Advances and Unanswered Questions. Curr Oncol Rep. 2020;22:14.

Giacalone NJ, Shipley WU, Clayman RH, Niemierko A, Drumm M, Heney NM, et al. Long-term Outcomes After Bladder-preserving Tri-modality Therapy for Patients with Muscle-invasive Bladder Cancer: An Updated Analysis of the Massachusetts General Hospital Experience. Eur Urol. 2017;71:952-60.

Pos FJ, Hart G, Schneider C, Sminia P. Radical radiotherapy for invasive bladder cancer: What dose and fractionation schedule to choose? Int J Radiat Oncol Biol. 2006;64:1168-73.

McBain CA, Logue JP. Radiation therapy for muscle-invasive bladder cancer: treatment planning and delivery in the 21st century. Semin Radiat Oncol. 2005;15:42-48.

Murthy V, Gupta P, Baruah K, Krishnatry R, Joshi A, Prabhash K, et al. Adaptive Radiotherapy for Carcinoma of the Urinary Bladder: Long-term Outcomes With Dose Escalation. Clin Oncol (R Coll Radiol). 2019;31(9):646-52.

Efstathiou JA, Spiegel DY, Shipley WU, Heney NM, Kaufman DS, Niemierko A, et al. Long‐term outcomes of selective bladder preservation by combined‐modality therapy for invasive bladder cancer: The MGH experience. Eur Urol 2012;61:705-11

Rödel C, Grabenbauer GG, Kühn R, Papadopoulos T, Dunst J, Meyer M, et al. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol. 2002;20:3061-71.

Chen RC, Shipley WU, Efstathiou JA, Zietman AL. Trimodality bladder preservation therapy for muscle-invasive bladder cancer. J Natl Compr Cancer Netw. 2013;11:952-60.

International collaboration of trialists. International phase III trial assessing neoadjuvant cisplatin, methotrexate, and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011;29(16):2171-7.

Michaelson MD, Hu C, Pham HT, Dahl DM, Wu CL, Swanson GP, et al. A phase 1 / 2 trial of a combination of paclitaxel and trastuzumab with daily irradiation or paclitaxel alone with daily irradiation after transurethral surgery for noncystectomy candidates with muscle-invasive bladder cancer (Trial NRG Oncology RTOG 0524). Int J Radiat Oncol Biol Phys. 2016;97:995-1001.

Hoskin PJ, Rojas AM, Bentzen SM, Saunders MI. Radiotherapy with concurrent carbogen and nicotinamide in bladder carcinoma. J Clin Oncol. 2010;28:4912-8.