Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience
Cancer Research Journal
Volume 7, Issue 1, March 2019, Pages: 1-7
Received: Dec. 7, 2018;
Accepted: Dec. 19, 2018;
Published: Jan. 24, 2019
Views 212 Downloads 40
Eman Awad Abd Allah, Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
Fatma Mohamed Farouk Akl, Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
Seham Elsayed-Abd-Alkhalek, Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
Background & objective: Bladder preservation therapy (BPT) using a trimodality approach represents an alternative option to cystectomy inmuscle-invasive bladder cancer (MIBC) patients, also a treatment option in non-cystectomy candidates. The objective of this study was to evaluate BPT using a trimodality approach composed of maximum TURBT, neoadjuvant chemotherapy, followed by chemoradiotherapy, regarding the overall survival (OS), progression free survival (PFS), locoregional progression free survival (LPFS) and treatment toxicity. Patients & methods: This prospective study involved 47 patients with pathologically proven MIBC (T2-T4a N0M0). The study involved muscle invasive bladder cancer patients who refused or were not cystectomycandidates. Patients enrolled received neoadjuvant 3cycles of Gemcitabine/Cisplatin, each cycle was every 21 days. Gemcitabine at 1000mg/m2 on days 1&8 and cisplatin at 70mg/m2 on day1, followed by Concurrent chemordiotherapy with cisplatin weekly (40mg/m2). Radiation therapy included the whole bladder by 3D conformal planning to a dose of 64Gy/32Fxs. Results: Of the 47 patients, 25 (53.2%) patients expressed complete response (CR), while 22(46.8%) patients had incomplete response. The 4-year OS, PFS, and LPFS rates were 48%, 38%, and 42%, respectively. Acute genitourinary (GU) toxicity of Grade 1 and 2 occurs in 54% and 24%of patients, respectively, while acute gastrointestinal (GI) toxicity (colic &diarrhea) of Grade 1 and 2 occurs in 27.7% and 10.6 %of patients, respectively. Conclusion: For MIBC patients who are non-cystectomy candidates, or who are motivated to maintain their bladders, trimodality bladder preservation therapy (BPT) can be considered as an effective alternative to radical cystectomy.
Eman Awad Abd Allah,
Fatma Mohamed Farouk Akl,
Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer: Mansoura Experience, Cancer Research Journal.
Vol. 7, No. 1,
2019, pp. 1-7.
Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67(1):7.
Ibrahim A, Khaled H, Mikhail N, Baraka H, Kamel H. Cancer Incidence in Egypt: Results of the National Population-Based Cancer Registry Program. Journal of Cancer Epidemiology; Volume 2014, Article ID 437971, 18 pages, http://dx.doi.org/10.1155/2014/437971.
Amin MB, McKenney JK, Paner GP, Hansel DE, Grignon DJ, Montironi R, et al. ICUD-EAU International Consultation on Bladder Cancer 2012: pathology. Eur Urol. 2013;63:16–35.
Mirzaa A, and ChoudhuryaAb. Bladder Preservation for Muscle Invasive Bladder Cancer. Bl Cancer. 2016; 2(2): 151–163.
Caffo O, Fellin G, Graffer U, Luciani L. Assessment of quality of life after cystectomy or conservative therapy for patients with infiltrating bladder carcinoma. A survey by a self-administered questionnaire. Cancer 1996;76(9):1089–97. Erratum in: Cancer 1996;76(9):2037. [PubMed].
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(9):859.
RoseaT, Deala A, Ladoireb S, Cr´ehangeb G, Galskyc M, Rosenbergd J, etal. Patterns of Bladder Preservation Therapy Utilization for Muscle-Invasive. Bladder Cancer.2016; 405–413 DOI 10.3233/BLC-160072. IOS Press.
NCCN Guidelines Version 2.2015 Bladder Cancer. http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf.
Guidelines on Muscle-invasive and Metastatic Bladder Cancer European Association of Urology 2015. http://uroweb.org/wp-content/uploads/EAU-Guidelines-Muscleinvasive-and-Metastatic-Bladder-Cancer-2015-v1.pdf.
Huddart R, Birtle A, Lewis R, Bahl A, Falconer A, MaynardL, et al. Results of the SPARE Feasibility Study; Selective Bladder Preservation Against Radical Excision in Muscle Invasive T2/T3 Transitional Cell Carcinoma of the Bladder. International Journal of Radiation Oncology Biology Physics 2012;84(3):S119-S20.
Mak RH, Hunt D, Shipley WU, Efstathiou JA, Tester WJ, Hagan MP, et al. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder preserving combined modality therapy: A pooled analysis of radiation therapy oncology group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J ClinOncol 2014;32(34):3801-9.
Arcangeli G, Arcangeli S, Strigari L. A systematic review and meta-analysis of clinical trials of bladder-sparing trimodality treatment of muscle-invasive bladder cancer (MIBC). Crit Rev OncolHematol. 2015;94:105–115.
Gofrit ON, Nof R, Meirovitz A, Pode D, Frank S, Katz R, et al. Radical cystectomy vs. Chemoradiation in T2-4aN0M0 bladder cancer: A case-control study. UrolOncol 2015;33(1):19. [PubMed].
Kulkarni GS, Hermanns T, Wei Y, Bhindi B, Satkunasivam R, Athanasopoulos P, et al. Propensity score analysis of radical cystectomy versus bladder- sparing trimodal therapy in the setting of a multidisciplinary bladder cancer Clinic. J ClinOncol. 2017;35(20):2299-305.
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. Urol2017;71, 952–960.
Smelser WW, Austenfeld AM, Holzbeierlein MJ, Lee EK. Where are we with bladder preservation for muscle-invasive bladder cancer in 2017? Indian journal of urology 2017, 33, 2, 111–117.
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 ClinOncol 2001;19(3):666–675. [PubMed].
Pietzak EJ, Sterling ME, Smith ZL, Malkowicz SB, Guzzo TJ. Outcomes of radical cystectomy in potential candidates for bladder preservation therapy. Urology 2015;85(4):869–875. [PubMed].
Tunio MA, Hashmi A, Qayyum A, Mohsin R, Zaeem A. Whole-pelvis or bladder-only chemoradiation for lymph node-negative invasive bladder cancer: Single-institution experience Int J RadiatOncolBiolPhys 2012;82:457–462. [PubMed].
Chen R, Shipley W, Efstathiou J, and Zietman A. Trimodality Bladder Preservation Therapy for Muscle-Invasive Bladder Cancer. J NatlComprCancNetw2013;11:952-960.
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 ClinOncol 2002;20: 3061-3071. PMID: 12118019.
George L, Bladou F, Bardou VJ, Gravis G, Tallet A, Alzieu C, et al. Clinical outcome in patients with locally advanced bladder carcinoma treated with conservative multimodality therapy. Urology 2004;64: 488-493. doi: 10.1016/j.urology.2004.04.088. PMID: 15351577.
Cobo M, Delgado R, Gil S, Herruzo I, Baena V, Carabante F, et al. Conservative treatment with transurethral resection, neoadjuvant chemotherapy followed by radiochemotherapy in stage T2-3 transitional bladder cancer. Clinical & Translational Oncology: Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 2006;8(12):903–11. PubMed PMID: 17169764. Epub 2006/12/16.eng. [PubMed].
Weiss C, Engehausen DG, Krause FS, Papadopoulos T, Dunst J, Sauer R, et al. Radiochemotherapy with cisplatin and 5-fluorouracil after transurethral surgeryin patients with bladder cancer. Int J Radiat Oncol Biol Phys 2007;68: 1072-1080. doi: 10.1016/j.ijrobp.2007.01.054. PMID: 17467193.
Perdonà S, Autorino R, Damiano R, De Sio M, Morrica B, Meyer M, et al. Bladdersparing, combined-modality approach for muscle-invasive bladder cancer: amulti-institutional, long-term experience. Cancer 2008;112: 75-83. doi: 10.1002/cncr.23137. PMID: 18008364.
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 Urol2011; 61: 705-711. doi: 10.1016/j.eururo.2011.11.010. PMID: 22101114.
Takaoka E, Miyazaki J, Ishikawa H, Kawai K, Kimura T, Ishitsuka R, et al. Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer Japanese Journal of Clinical Oncology, Volume 47, Issue 1, 1 January 2017, Pages 67–73.
AlGizawy MS, Essa HH, Abdel-Wanis EM, and Abdel Raheem MA. Trimodality bladder-sparing approach versus radical cystectomy for invasive bladder cancer. Journal of Radiotherapy in Practice Volume 13, Issue 4 December 2014, pp. 428-437.
Munro NP, Sundaram SK, Weston PM, Fairley L, Harrison SC, Forman D, et al. A 10-year retrospective review of a nonrandomized cohort of 458 patients undergoing radical radiotherapy or cystectomy in Yorkshire, UK. Int J RadiatOncolBiolPhys 2010;77(1):119–124. [PubMed].
Kotwal S, Choudhury A, Johnston C, Paul AB, Whelan P, Kiltie AE. Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom specialist treatment center. Int J RadiatOncolBiolPhys 2008;70(2):456–463. [PubMed].
Rose LT, Deal AM, Ladoire S, Créhange G, Matthew D. Galsky M, et al the Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators. Patterns of Bladder Preservation Therapy Utilization for Muscle-Invasive Bladder Cancer. Bladder Cancer. 2016; 2(4): 405–413.
Hussain MH, Glass TR, Forman J, Sakr W, Smith DC, Al-Sarraf M, et al. Combination cisplatin, 5-fluorouracil and radiation therapy for locally advanced unresectable or medically unfit bladder cancer cases: A Southwest Oncology Group Study. J Urol2001;165(1):56–60; discussion -1. [PubMed].
Zietman AL, Sacco D, Skowronski U, Gomery P, Kaufman DS, Clark JA, et al. Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: Results of a urodynamic and quality of life study on long-term survivors. J Urol 2003;170(5):1772–1776.[PubMed].
Mak KS, Smith AB, Eidelman A, Clayman R, Niemierko A, Cheng JS, et al. Quality of life in long-term survivors of muscle-invasive bladder cancer. J ClinOncol 2015;33(suppl 7; abstr 319).