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Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience

PURPOSE: As an alternative to radical cystectomy, tri-modality treatment (TMT) is an effective treatment approach for selected patients with muscle-invasive bladder cancer (MIBC). The purpose of this report is to contribute to the literature by summarizing institutional outcomes of a bladder-preserv...

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Autores principales: Polineni, Praneet, Ashack, Laura, Kalapurakal, John, Morgans, Alicia, VanderWeele, David, Kundu, Shilajit, Hussain, Maha, Meeks, Joshua, Sachdev, Sean
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273199/
https://www.ncbi.nlm.nih.gov/pubmed/34286164
http://dx.doi.org/10.1016/j.adro.2021.100718
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author Polineni, Praneet
Ashack, Laura
Kalapurakal, John
Morgans, Alicia
VanderWeele, David
Kundu, Shilajit
Hussain, Maha
Meeks, Joshua
Sachdev, Sean
author_facet Polineni, Praneet
Ashack, Laura
Kalapurakal, John
Morgans, Alicia
VanderWeele, David
Kundu, Shilajit
Hussain, Maha
Meeks, Joshua
Sachdev, Sean
author_sort Polineni, Praneet
collection PubMed
description PURPOSE: As an alternative to radical cystectomy, tri-modality treatment (TMT) is an effective treatment approach for selected patients with muscle-invasive bladder cancer (MIBC). The purpose of this report is to contribute to the literature by summarizing institutional outcomes of a bladder-preserving TMT approach for patients with MIBC. METHODS AND MATERIALS: Patients treated with TMT for MIBC from 1998 to 2019 were identified. Patient, disease, and treatment factors were recorded. Overall survival (OS), disease-free survival (DFS), and bladder-preserved DFS were estimated with the Kaplan-Meier method. Prognostic factors were evaluated with Cox proportional hazards regression. RESULTS: Thirty-two patients treated with TMT to a median dose of 64.8 Gy for T2 (78%), T3 (19%), and T4 (3%) disease were followed for a median of 19 months (mean, 36; range, 6-213); 31% had associated carcinoma in situ; 25% had associated hydronephrosis. Cisplatin was the most commonly used chemotherapeutic agent. OS rates were 84% at 1 year and 61% at 5 years. DFS rates were 84% and 61% and bladder-preserved DFS rates were 84% and 60% at 1 year and 5 years, respectively. Salvage cystectomy rates at 1 year and 5 years were 4% and 9%, respectively. Four patients had locally invasive recurrences at 8, 11, 34, and 37 months after initial MIBC diagnosis, 2 of whom underwent salvage radical cystectomy. Ten (31%) patients developed distant disease at a median of 13 months after diagnosis. Unlike local recurrence, distant recurrences were associated with worse OS and hazard ratios of 3.4 (P = 0.039). CONCLUSIONS: OS and DFS were comparable to those of published data. Our outcomes support TMT as an effective option for carefully selected patients with MIBC.
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spelling pubmed-82731992021-07-19 Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience Polineni, Praneet Ashack, Laura Kalapurakal, John Morgans, Alicia VanderWeele, David Kundu, Shilajit Hussain, Maha Meeks, Joshua Sachdev, Sean Adv Radiat Oncol Research Letter PURPOSE: As an alternative to radical cystectomy, tri-modality treatment (TMT) is an effective treatment approach for selected patients with muscle-invasive bladder cancer (MIBC). The purpose of this report is to contribute to the literature by summarizing institutional outcomes of a bladder-preserving TMT approach for patients with MIBC. METHODS AND MATERIALS: Patients treated with TMT for MIBC from 1998 to 2019 were identified. Patient, disease, and treatment factors were recorded. Overall survival (OS), disease-free survival (DFS), and bladder-preserved DFS were estimated with the Kaplan-Meier method. Prognostic factors were evaluated with Cox proportional hazards regression. RESULTS: Thirty-two patients treated with TMT to a median dose of 64.8 Gy for T2 (78%), T3 (19%), and T4 (3%) disease were followed for a median of 19 months (mean, 36; range, 6-213); 31% had associated carcinoma in situ; 25% had associated hydronephrosis. Cisplatin was the most commonly used chemotherapeutic agent. OS rates were 84% at 1 year and 61% at 5 years. DFS rates were 84% and 61% and bladder-preserved DFS rates were 84% and 60% at 1 year and 5 years, respectively. Salvage cystectomy rates at 1 year and 5 years were 4% and 9%, respectively. Four patients had locally invasive recurrences at 8, 11, 34, and 37 months after initial MIBC diagnosis, 2 of whom underwent salvage radical cystectomy. Ten (31%) patients developed distant disease at a median of 13 months after diagnosis. Unlike local recurrence, distant recurrences were associated with worse OS and hazard ratios of 3.4 (P = 0.039). CONCLUSIONS: OS and DFS were comparable to those of published data. Our outcomes support TMT as an effective option for carefully selected patients with MIBC. Elsevier 2021-05-20 /pmc/articles/PMC8273199/ /pubmed/34286164 http://dx.doi.org/10.1016/j.adro.2021.100718 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Letter
Polineni, Praneet
Ashack, Laura
Kalapurakal, John
Morgans, Alicia
VanderWeele, David
Kundu, Shilajit
Hussain, Maha
Meeks, Joshua
Sachdev, Sean
Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience
title Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience
title_full Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience
title_fullStr Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience
title_full_unstemmed Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience
title_short Trimodality Treatment for Muscle-Invasive Bladder Cancer: An Institutional Experience
title_sort trimodality treatment for muscle-invasive bladder cancer: an institutional experience
topic Research Letter
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273199/
https://www.ncbi.nlm.nih.gov/pubmed/34286164
http://dx.doi.org/10.1016/j.adro.2021.100718
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