Outcome following radical cystectomy and bladder-preservation therapy in patients with invasive carcinoma of urinary bladder
Identifieur interne : 000730 ( Main/Exploration ); précédent : 000729; suivant : 000731Outcome following radical cystectomy and bladder-preservation therapy in patients with invasive carcinoma of urinary bladder
Auteurs : B. S. Yadav [Inde] ; S. Ghoshal [Inde] ; S. C. Sharma [Inde]Source :
- Indian Journal of Urology : IJU : Journal of the Urological Society of India [ 0970-1591 ] ; 2008.
Abstract
Invasive bladder cancer is a lethal disease with a 50% cancer-related mortality even in the best healthcare systems. Optimum combination of surgery, external beam radiotherapy and platinum-based chemotherapy has yet to be determined.
To audit the outcome of multi-modality treatment and compare this with the existing literature in order to set future priorities and re-audit in patients with invasive carcinoma of urinary bladder.
Between January 2001 and December 2004, 97 patients with invasive carcinoma of urinary bladder were analyzed. Radical surgery was done in 18(18%) patients and adjuvant radiation was given to 20(21%) patients. Radical radiation alone, (≥50 Gy) was given to 26(27%) and chemoradiation to 33(34%) patients respectively. Patients in the chemoradiation arm were given the same dose of radiation with weekly concomitant cisplatin at 40 mg/ m2 one hour before radiation during the first phase only. At a median follow-up of 32 months the outcome studied included locoregional failure, distant failure, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. The OS and DFS were calculated according to Kaplan-Meier. Log rank test was used for statistical significance.
Median age of the patients was 58 years. Males comprised 93% of the total patients. Most (93%) of the patients had transitional cell histology. In patients treated with radiation alone overall response rate was 60%, with a complete response (CR) rate of 42%. The CR in patients treated with chemoradiation was 51%. Bladder was preserved in 61% of patients who received chemoradiation as compared to 42% in patients treated with radical radiation. With radical radiation local recurrence rate was 19% as compared to 22% with surgery and 6% with chemoradiation, respectively. Local recurrence rate was only 5% in patients treated with adjuvant radiation. Distant metastasis rate was least with chemoradiation (9%) as compared to 11.5% in radical radiation: curable dose of radiation and 33% with surgery alone, respectively. Patients with adjuvant radiation had a distant metastases rate of 15%. Median OS was 36 months. Factors affecting OS were histology (
In patients with invasive bladder cancer, combined modality in the form of radical cystectomy followed by radiation give best local control. Radiation alone is not effective to control muscle-invasive local disease; however, Chemoradiation is an effective alternative to radical cystectomy to preserve bladder function.
Url:
DOI: 10.4103/0970-1591.38603
PubMed: 19468359
PubMed Central: 2684249
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Outcome following radical cystectomy and bladder-preservation therapy in patients with invasive carcinoma of urinary bladder</title><author><name sortKey="Yadav, B S" sort="Yadav, B S" uniqKey="Yadav B" first="B. S." last="Yadav">B. S. Yadav</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Radiotherapy, PGIMER, Chandigarh, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiotherapy, PGIMER, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Ghoshal, S" sort="Ghoshal, S" uniqKey="Ghoshal S" first="S." last="Ghoshal">S. Ghoshal</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Radiotherapy, PGIMER, Chandigarh, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiotherapy, PGIMER, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Sharma, S C" sort="Sharma, S C" uniqKey="Sharma S" first="S. C." last="Sharma">S. C. Sharma</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Radiotherapy, PGIMER, Chandigarh, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiotherapy, PGIMER, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19468359</idno><idno type="pmc">2684249</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684249</idno><idno type="RBID">PMC:2684249</idno><idno type="doi">10.4103/0970-1591.38603</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">000419</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000419</idno><idno type="wicri:Area/Pmc/Curation">000418</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000418</idno><idno type="wicri:Area/Pmc/Checkpoint">000339</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000339</idno><idno type="wicri:Area/Ncbi/Merge">000103</idno><idno type="wicri:Area/Ncbi/Curation">000103</idno><idno type="wicri:Area/Ncbi/Checkpoint">000103</idno><idno type="wicri:doubleKey">0970-1591:2008:Yadav B:outcome:following:radical</idno><idno type="wicri:Area/Main/Merge">000736</idno><idno type="wicri:Area/Main/Curation">000730</idno><idno type="wicri:Area/Main/Exploration">000730</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Outcome following radical cystectomy and bladder-preservation therapy in patients with invasive carcinoma of urinary bladder</title><author><name sortKey="Yadav, B S" sort="Yadav, B S" uniqKey="Yadav B" first="B. S." last="Yadav">B. S. Yadav</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Radiotherapy, PGIMER, Chandigarh, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiotherapy, PGIMER, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Ghoshal, S" sort="Ghoshal, S" uniqKey="Ghoshal S" first="S." last="Ghoshal">S. Ghoshal</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Radiotherapy, PGIMER, Chandigarh, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiotherapy, PGIMER, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author><author><name sortKey="Sharma, S C" sort="Sharma, S C" uniqKey="Sharma S" first="S. C." last="Sharma">S. C. Sharma</name><affiliation wicri:level="1"><nlm:aff id="AF0001">Department of Radiotherapy, PGIMER, Chandigarh, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Radiotherapy, PGIMER, Chandigarh</wicri:regionArea><wicri:noRegion>Chandigarh</wicri:noRegion></affiliation></author></analytic><series><title level="j">Indian Journal of Urology : IJU : Journal of the Urological Society of India</title><idno type="ISSN">0970-1591</idno><idno type="eISSN">1998-3824</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>Invasive bladder cancer is a lethal disease with a 50% cancer-related mortality even in the best healthcare systems. Optimum combination of surgery, external beam radiotherapy and platinum-based chemotherapy has yet to be determined.</p></sec><sec id="st2"><title>Purpose:</title><p>To audit the outcome of multi-modality treatment and compare this with the existing literature in order to set future priorities and re-audit in patients with invasive carcinoma of urinary bladder.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>Between January 2001 and December 2004, 97 patients with invasive carcinoma of urinary bladder were analyzed. Radical surgery was done in 18(18%) patients and adjuvant radiation was given to 20(21%) patients. Radical radiation alone, (≥50 Gy) was given to 26(27%) and chemoradiation to 33(34%) patients respectively. Patients in the chemoradiation arm were given the same dose of radiation with weekly concomitant cisplatin at 40 mg/ m<sup>2</sup> one hour before radiation during the first phase only. At a median follow-up of 32 months the outcome studied included locoregional failure, distant failure, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. The OS and DFS were calculated according to Kaplan-Meier. Log rank test was used for statistical significance.</p></sec><sec id="st4"><title>Results:</title><p>Median age of the patients was 58 years. Males comprised 93% of the total patients. Most (93%) of the patients had transitional cell histology. In patients treated with radiation alone overall response rate was 60%, with a complete response (CR) rate of 42%. The CR in patients treated with chemoradiation was 51%. Bladder was preserved in 61% of patients who received chemoradiation as compared to 42% in patients treated with radical radiation. With radical radiation local recurrence rate was 19% as compared to 22% with surgery and 6% with chemoradiation, respectively. Local recurrence rate was only 5% in patients treated with adjuvant radiation. Distant metastasis rate was least with chemoradiation (9%) as compared to 11.5% in radical radiation: curable dose of radiation and 33% with surgery alone, respectively. Patients with adjuvant radiation had a distant metastases rate of 15%. Median OS was 36 months. Factors affecting OS were histology (<italic>P</italic> = 0.023) and nodal involvement (<italic>P</italic> = 0.034). Median DFS was 26 months. Significant factors affecting DFS on univariate analysis were histology (<italic>P</italic> = 0.046) and nodal involvement (<italic>P</italic> = 0.004). On multivariate analysis the only factor affecting DFS and OS was nodal involvement (P = 0.01; Hazard Ratio, 0.085-0.719).</p></sec><sec id="st5"><title>Conclusion:</title><p>In patients with invasive bladder cancer, combined modality in the form of radical cystectomy followed by radiation give best local control. Radiation alone is not effective to control muscle-invasive local disease; however, Chemoradiation is an effective alternative to radical cystectomy to preserve bladder function.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Shipley, Wu" uniqKey="Shipley W">WU Shipley</name></author><author><name sortKey="Kaufman, Ds" uniqKey="Kaufman D">DS Kaufman</name></author><author><name sortKey="Tester, Wj" uniqKey="Tester W">WJ Tester</name></author><author><name sortKey="Pilepich, Mv" uniqKey="Pilepich M">MV Pilepich</name></author><author><name sortKey="Sandler, Hm" uniqKey="Sandler H">HM Sandler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="James, N" uniqKey="James N">N James</name></author><author><name sortKey="Hussain, As" uniqKey="Hussain A">AS Hussain</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hayter, Cr" uniqKey="Hayter C">CR 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sortKey="Ohara, K" uniqKey="Ohara K">K Ohara</name></author><author><name sortKey="Sugahara, S" uniqKey="Sugahara S">S Sugahara</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jahnson, S" uniqKey="Jahnson S">S Jahnson</name></author><author><name sortKey="Pedersen, J" uniqKey="Pedersen J">J Pedersen</name></author><author><name sortKey="Westman, G" uniqKey="Westman G">G Westman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodel, C" uniqKey="Rodel C">C Rodel</name></author><author><name sortKey="Weiss, C" uniqKey="Weiss C">C Weiss</name></author><author><name sortKey="Saur, R" uniqKey="Saur R">R Saur</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Inde</li></country></list><tree><country name="Inde"><noRegion><name sortKey="Yadav, B S" sort="Yadav, B S" uniqKey="Yadav B" first="B. S." last="Yadav">B. S. Yadav</name></noRegion><name sortKey="Ghoshal, S" sort="Ghoshal, S" uniqKey="Ghoshal S" first="S." last="Ghoshal">S. Ghoshal</name><name sortKey="Sharma, S C" sort="Sharma, S C" uniqKey="Sharma S" first="S. C." last="Sharma">S. C. Sharma</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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