Neoadjuvant Chemotherapy-Guided Bladder-Sparing Treatment for Muscle-Invasive Bladder Cancer: Results of a Pilot Phase II Study

Autor: Shan Zheng, You-yan Guan, Kaopeng Guan, Hongsong Bai, Wen Zhang, Hongzhe Shi, Jianhui Ma, Yueping Liu, Changling Li, Weixing Jiang, Dong Wang, Zhilong Hu, Xingang Bi, Jin Zhang, Jun Tian, Linjun Hu, Yan Chen, Chuanzhen Cao, Jianzhong Shou, Aiping Zhou, Xiao-Li Feng, Zejun Xiao, Yexiong Li
Rok vydání: 2020
Předmět:
0301 basic medicine
Male
Cancer Research
medicine.medical_treatment
Deoxycytidine
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
Clinical endpoint
Medicine
Prospective Studies
Neoadjuvant therapy
Muscle Neoplasms
medicine.diagnostic_test
Remission Induction
Combined modality therapy
Chemoradiotherapy
Middle Aged
Prognosis
Neoadjuvant Therapy
Survival Rate
Oncology
030220 oncology & carcinogenesis
Female
Original Article
Muscle-invasive bladder cancer
Adult
medicine.medical_specialty
Urology
Cystectomy
Genitourinary Cancer
03 medical and health sciences
Organ sparing treatments
Combined Modality Therapy
Humans
Neoplasm Invasiveness
Urine cytology
Aged
Retrospective Studies
Bladder cancer
business.industry
Cystoscopy
medicine.disease
Gemcitabine
030104 developmental biology
Urinary Bladder Neoplasms
Quality of Life
Cisplatin
Neoplasm Recurrence
Local
business
Follow-Up Studies
Zdroj: Cancer Research and Treatment : Official Journal of Korean Cancer Association
ISSN: 2005-9256
Popis: Purpose Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy.Materials and Methods Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate.Results Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory.Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.
Databáze: OpenAIRE
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