Clinical outcome in patients with locally advanced bladder carcinoma treated with conservative multimodality therapy
| Autor: | Valerie Jeanne Bardou, Franck Bladou, Luc George, Gwenaelle Gravis, Gérard Serment, C. Alzieu, Naji Salem, Agnès Tallet |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_treatment Salvage therapy Carboplatin chemistry.chemical_compound Antineoplastic Combined Chemotherapy Protocols Life Tables Neoadjuvant therapy Aged 80 and over education.field_of_study Middle Aged Combined Modality Therapy Neoadjuvant Therapy Treatment Outcome Chemotherapy Adjuvant Female Fluorouracil Adult medicine.medical_specialty Urology Population Cystectomy Vinblastine Disease-Free Survival medicine Humans Neoplasm Invasiveness education Aged Retrospective Studies Salvage Therapy Carcinoma Transitional Cell Bladder cancer business.industry Muscle Smooth medicine.disease Survival Analysis Surgery Methotrexate Urinary Bladder Neoplasms chemistry Doxorubicin Concomitant Radiotherapy Adjuvant Cisplatin business Chemoradiotherapy Follow-Up Studies |
| Zdroj: | Urology. 64:488-493 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2004.04.088 |
| Popis: | Objectives To describe the outcome of patients with muscle-invasive bladder carcinoma treated with multimodality therapy in our institution from 1993 to 2002. Methods The charts of 60 patients with Stage T2-T4N0-N1M0 treated with transurethral resection of bladder tumor followed by a chemoradiotherapy combination were retrospectively reviewed. Of the 60 patients, 22 had received neoadjuvant chemotherapy (methotrexate, cisplatin, and vinblastine or methotrexate, adriamycin, cisplatin, and vinblastine) followed by concomitant chemoradiotherapy (weekly cisplatin/carboplatin or a cisplatin and 5-fluorouracil combination), and 38 had received concomitant chemoradiotherapy alone. Radiotherapy delivered a median dose of 45 Gy to the pelvis and 65 Gy to the bladder in a once-daily or twice-daily fractionation scheme. Follow-up evaluations included cystoscopy with biopsies at regular intervals. Salvage cystectomy was recommended in the case of local persistent tumor or bladder relapse. Results The median follow-up was 48.5 months (range 10 to 126). Of the 22 patients who received neoadjuvant chemotherapy, 18 (82%) had received two or more cycles; 51 (85%) of the 60 patients received the concomitant chemotherapy as planned. Radiotherapy was completed in 56 patients. Twenty-eight patients developed relapse either locally (14 did not achieve a complete local response after chemoradiotherapy and 6 had true local relapse during follow-up) or at distant sites. The actuarial 5-year disease-specific survival and freedom from local and distant relapse rate was 54% and 42%, respectively. The actuarial local control rate with an intact bladder was 56% at 5 years. When stratified according to stage and grade, patients with Stage T2-T3, grade 2 tumors had a statistically significantly better chance of remaining relapse free than did the others ( P = 0.045). Salvage cystectomy (n = 11) for isolated local failure in this population achieved limited results. Conclusions Transurethral resection of bladder tumor with this chemoradiotherapy combination achieved satisfactory results in this unfavorable population with invasive bladder carcinoma. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect