| Autor: |
Trifanescu OG; Department of Oncology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Radiotherapy II, 022328 Bucharest, Romania., Gales LN; Department of Oncology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Medical Oncology II, 022328 Bucharest, Romania., Paun MA; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Radiotherapy II, 022328 Bucharest, Romania., Motas N; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Thoracic Surgery, 022328 Bucharest, Romania.; Department of Thoracic Surgery, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Marinescu SA; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Oncologic Surgery I, 022328 Bucharest, Romania., Virtosu I; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Radiotherapy II, 022328 Bucharest, Romania., Trifanescu RA; Institute of Endocrinology 'C. I Parhon', 011863 Bucharest, Romania.; Department of Endocrinology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Gherghe M; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Nuclear Medicine, 022328 Bucharest, Romania.; Department of Nuclear Medicine, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Bilteanu L; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Radiotherapy II, 022328 Bucharest, Romania., Diaconu CC; Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.; Department of Internal Medicine, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania., Anghel RM; Department of Oncology, University of Medicine and Pharmacy 'Carol Davila', 050474 Bucharest, Romania.; Institute of Oncology 'Prof. Dr. Al. Trestioreanu' Bucharest, Radiotherapy II, 022328 Bucharest, Romania. |
| Abstrakt: |
Background and Objectives : There is no consensus regarding the optimal therapy sequence in stage II and III bladder cancer. The study aimed to evaluate the long-term oncologic outcomes in patients with bladder cancer after a multimodality approach. Materials and methods : Medical files of 231 consecutive patients identified with stage II (46.8%), IIIA (30.3%), and IIIB (22.9%) transitional cell carcinoma of the bladder (BC) treated with a multimodality approach were retrospectively reviewed. The treatment consisted of transurethral resections or cystectomy, radiotherapy alone or concurrent chemoradiotherapy as definitive treatment, or neoadjuvant chemotherapy using platinum salt regimens. Results : Median age at diagnosis was 65 ± 10.98 years. Radical or partial cystectomy was performed in 88 patients (37.1%), and trans-urethral resection of bladder tumor (TURBT) alone was performed in 143 (61.9%) patients. Overall, 40 patients (17.3%) received neoadjuvant chemotherapy and 82 (35.5%) received definitive chemoradiotherapy. After a median follow-up of 30.6 months (range 3-146 months), the median disease-free survival (DFS) for an entire lot of patients was 32 months, and the percentage of patients without recurrence at 12, 24, and 36 months was 86%, 58%, and 45%, respectively. Patients receiving neoadjuvant chemotherapy had a better oncologic outcome compared to patients without neoadjuvant chemotherapy (median DFS not reached vs. 31 months, p = 0.038, HR = 0.55, 95% CI 0.310-0.951). There was a trend for better 3-year DFS with radical cystectomy vs. TURBT (60 months vs. 31 months, p = 0.064). Definitive chemoradiotherapy 3-year DFS was 58% compared to 44% in patients who received radiotherapy or chemotherapy alone. Conclusions : In patients with stages II and III, both neoadjuvant chemotherapy and concurrent radio-chemotherapy are valid options for treatment and must be part of a multidisciplinary approach. |
