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Bladder cancer downstaging

Mohammad Abufaraj, Beat Foerster, Eva Schernhammer, Marco Moschini, Shoji Kimura, Melanie R Hassler, Mark A Preston, Pierre I Karakiewicz, Mesut Remzi, Shahrokh F Shariat
CONTEXT: The optimal treatment of urothelial bladder cancer (UBC) with micropapillary (MP) variant histology is not clear. OBJECTIVE: To review the current literature on disease characteristics and treatment outcomes of MP UBC. EVIDENCE ACQUISITION: A systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions...
December 12, 2018: European Urology
Timothy D Lyon, Igor Frank, Vidit Sharma, Paras H Shah, Matthew K Tollefson, R Houston Thompson, R Jeffrey Karnes, Prabin Thapa, John C Cheville, Stephen A Boorjian
PURPOSE: To validate published risk criteria for informing use of neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC), and to examine outcomes of low-risk (LR) patients treated with immediate radical cystectomy (RC). METHODS: We identified 1931 patients who underwent RC for MIBC from 1980 to 2016. Patients were considered high risk (HR) with hydronephrosis, lymphovascular invasion, variant histology and/or cT3/4 disease. Kaplan-Meier survival estimates were compared to patients classified as LR, and logistic regression was used to examine factors associated with pathologic downstaging...
November 3, 2018: World Journal of Urology
Charles C Peyton, Dominic Tang, Richard R Reich, Mounsif Azizi, Juan Chipollini, Julio M Pow-Sang, Brandon Manley, Philippe E Spiess, Michael A Poch, Wade J Sexton, Mayer Fishman, Jingsong Zhang, Scott M Gilbert
Importance: Neoadjuvant chemotherapy (NAC) followed by radical cystectomy improves survival compared with cystectomy alone for patients with bladder cancer. Although gemcitabine with cisplatin has become a standard NAC regimen, a dose-dense combination of methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) is being adopted at some institutions. Objective: To assess the association of neoadjuvant ddMVAC vs standard regimens with downstaging and overall survival among patients treated with radical cystectomy for bladder cancer...
November 1, 2018: JAMA Oncology
Satoko Arai, Tomohiko Hara, Yoshiyuki Matsui, Keiichi Koido, Hironobu Hashimoto, Yasuo Shinoda, Motokiyo Komiyama, Hiroyuki Fujimoto, Hiroyuki Terakado
Objective: Compared with standard treatment, a modified tri-weekly MVAC (methotrexate, doxorubicin, vinblastine, and cisplatin) treatment regimen with a high cisplatin dose intensity shows good efficacy and lower toxicity. Thus, we retrospectively investigated the tolerability and efficacy of a modified tri-weekly MVAC neoadjuvant regimen. Methods: We analyzed 25 patients with locally advanced bladder cancer medicated by a modified tri-weekly MVAC neoadjuvant regimen that omits treatment on days 15 and 22...
May 2018: Case Reports in Oncology
Ayman Soubra, Mehmet Gencturk, Jerry Froelich, Priya Balaji, Shilpa Gupta, Gautam Jha, Badrinath R Konety
PURPOSE: To determine the accuracy of 18 F-fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET/CT) scans in assessing the response to neoadjuvant chemotherapy (NAC) in patients with bladder cancer scheduled to undergo radical cystectomy (RC). PATIENTS AND METHODS: All patients treated at our center for muscle-invasive bladder cancer (MIBC) were counseled and offered NAC before RC. FDG-PET/CT scans were performed before the initiation of chemotherapy and after completion of the regimen...
May 31, 2018: Clinical Genitourinary Cancer
Gopa Iyer, Arjun V Balar, Matthew I Milowsky, Bernard H Bochner, Guido Dalbagni, S Machele Donat, Harry W Herr, William C Huang, Samir S Taneja, Michael Woods, Irina Ostrovnaya, Hikmat Al-Ahmadie, Maria E Arcila, Jamie C Riches, Andreas Meier, Caitlin Bourque, Maha Shady, Helen Won, Tracy L Rose, William Y Kim, Brooke E Kania, Mariel E Boyd, Catharine K Cipolla, Ashley M Regazzi, Daniela Delbeau, Asia S McCoy, Hebert Alberto Vargas, Michael F Berger, David B Solit, Jonathan E Rosenberg, Dean F Bajorin
Purpose Neoadjuvant chemotherapy followed by radical cystectomy (RC) is a standard of care for the management of muscle-invasive bladder cancer (MIBC). Dose-dense cisplatin-based regimens have yielded favorable outcomes compared with standard-dose chemotherapy, yet the optimal neoadjuvant regimen remains undefined. We assessed the efficacy and tolerability of six cycles of neoadjuvant dose-dense gemcitabine and cisplatin (ddGC) in patients with MIBC. Patients and Methods In this prospective, multicenter phase II study, patients received ddGC (gemcitabine 2,500 mg/m2 on day 1 and cisplatin 35 mg/m2 on days 1 and 2) every 2 weeks for 6 cycles followed by RC...
July 1, 2018: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Tom J N Hermans, Charlotte S Voskuilen, Michiel S van der Heijden, Bernd J Schmitz-Dräger, Wassim Kassouf, Roland Seiler, Ashish M Kamat, Petros Grivas, Anne E Kiltie, Peter C Black, Bas W G van Rhijn
BACKGROUND: Approximately half of patients who undergo radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) will succumb to metastatic disease. We summarize the evidence for neoadjuvant radiation (NAR), chemo (NAC), and immunotherapy (checkpoint inhibition) prior to RC for MIBC. MATERIALS AND METHODS: Data were obtained by a search of PubMed,, and Cochrane databases for English language articles published from 1925 up to 2017. RESULTS: NAC usage has increased over the last decade, while NAR is rarely administered...
September 2018: Urologic Oncology
Akinori Minato, Naohiro Fujimoto, Tatsuhiko Kubo
OBJECTIVE: The efficacy of chemotherapy on UCSD is not known. This study was conducted to investigate the efficacy of cisplatin-based chemotherapy and prognosis of patients with UC with or without SD of the bladder. METHODS: Patients with invasive bladder cancer (clinical T3-4aN0M0) who were treated between March 2003 and March 2015 with 2 or 3 cycles of neoadjuvant chemotherapy followed by radical cystectomy were retrospectively evaluated. Treatment outcomes were compared for each pathologic type in UCSD and pure UC...
December 2017: Clinical Genitourinary Cancer
E E Fransen van de Putte, E Vegt, L S Mertens, A Bruining, K Hendricksen, M S van der Heijden, S Horenblas, B W G van Rhijn
PURPOSE: We investigated the accuracy of FDG-PET/CT response identification following neoadjuvant or induction chemotherapy (NAIC) for invasive bladder cancer (BC) as to better select patients for radical cystectomy (RC). METHODS: Between 2010 and 2014, 37 cT1-4N1-3 BC patients received a FDG-PET/CT before and after NAIC followed by RC. Metabolic lymph node (LN) response was evaluated according to EORTC recommendations. Additionally, primary tumor response was evaluated for 23 patients by means of delayed pelvic imaging after forced diuresis...
September 2017: International Urology and Nephrology
Andrew R Leone, Kamran Zargar-Shoshtari, Gregory J Diorio, Pranav Sharma, David Boulware, Scott M Gilbert, Julio M Powsang, Jingsong Zhang, Wade J Sexton, Philippe E Spiess, Michael A Poch
INTRODUCTION: We conducted this study to determine if, in appropriately selected elderly patients receiving neoadjuvant chemotherapy (NAC), clinical outcomes including pathologic complete response/downstaging and overall survival were similar to a younger cohort. METHODS: Chart review was performed on patients receiving NAC for urothelial carcinoma of the bladder (UCB) from 2004 to 2013. A total of 116 patients were identified that underwent NAC from 2004 to 2013 for ≥ cT2N0M0 UCB...
August 2017: Clinical Genitourinary Cancer
Roland Seiler, Hussam Al Deen Ashab, Nicholas Erho, Bas W G van Rhijn, Brian Winters, James Douglas, Kim E Van Kessel, Elisabeth E Fransen van de Putte, Matthew Sommerlad, Natalie Q Wang, Voleak Choeurng, Ewan A Gibb, Beatrix Palmer-Aronsten, Lucia L Lam, Christine Buerki, Elai Davicioni, Gottfrid Sjödahl, Jordan Kardos, Katherine A Hoadley, Seth P Lerner, David J McConkey, Woonyoung Choi, William Y Kim, Bernhard Kiss, George N Thalmann, Tilman Todenhöfer, Simon J Crabb, Scott North, Ellen C Zwarthoff, Joost L Boormans, Jonathan Wright, Marc Dall'Era, Michiel S van der Heijden, Peter C Black
BACKGROUND: An early report on the molecular subtyping of muscle-invasive bladder cancer (MIBC) by gene expression suggested that response to neoadjuvant chemotherapy (NAC) varies by subtype. OBJECTIVE: To investigate the ability of molecular subtypes to predict pathological downstaging and survival after NAC. DESIGN, SETTING, AND PARTICIPANTS: Whole transcriptome profiling was performed on pre-NAC transurethral resection specimens from 343 patients with MIBC...
October 2017: European Urology
Consuelo Buttigliero, Marcello Tucci, Francesca Vignani, Giorgio V Scagliotti, Massimo Di Maio
Cystectomy is the gold standard for treatment of localized muscle-invasive bladder cancer. However, about 50% of patients develop metastases within 2years after cystectomy and subsequently die for the disease. Neoadjuvant cisplatin-based chemotherapy before cystectomy improves the overall survival in patients with muscle-invasive bladder cancer, and pathological response to neoadjuvant treatment (downstaging to ⩽pT1 at cystectomy) is a strong predictor of better disease-specific survival. Nevertheless, some patients do not benefit from neoadjuvant therapy...
March 2017: Cancer Treatment Reviews
Samuel A Funt, Jonathan E Rosenberg
Many patients diagnosed with muscle-invasive bladder cancer (MIBC) will develop distant metastatic disease. Over the past three decades, perioperative cisplatin-based chemotherapy has been investigated for its ability to reduce the number of deaths from bladder cancer. Insufficient evidence is available to fully support the use of such chemotherapy in the adjuvant setting; however, neoadjuvant cisplatin-based combination chemotherapy has become a standard of care for eligible patients based on the improved disease-specific and overall survival demonstrated in two randomized phase III trials, compared with surgery alone...
April 2017: Nature Reviews. Clinical Oncology
Tom J N Hermans, Elisabeth E Fransen van de Putte, Simon Horenblas, Richard P Meijer, Joost L Boormans, Katja K H Aben, Michiel S van der Heijden, Ronald de Wit, Laurens V Beerepoot, Rob H A Verhoeven, Bas W G van Rhijn
BACKGROUND: Induction chemotherapy (IC) for clinically node-positive bladder cancer is applied without clinical evidence of improved outcome. Our objective was to compare complete pathological downstaging (pCD) and overall survival (OS) for IC versus upfront radical cystectomy (RC) in cT1-4aN1-3M0 urothelial carcinoma (UC). METHODS: This population-based study included 659 cN+ patients treated with RC between 1995 and 2013. IC was applied in 212 (32%) patients...
December 2016: European Journal of Cancer
Mario I Fernández, Stephen B Williams, Daniel L Willis, Rebecca S Slack, Rian J Dickstein, Sahil Parikh, Edmund Chiong, Arlene O Siefker-Radtke, Charles C Guo, Bogdan A Czerniak, David J McConkey, Jay B Shah, Louis L Pisters, H Barton Grossman, Colin P N Dinney, Ashish M Kamat
OBJECTIVE: To analyse survival in patients with clinically localised, surgically resectable micropapillary bladder cancer (MPBC) undergoing radical cystectomy (RC) with and without neoadjuvant chemotherapy (NAC) and develop risk strata based on outcome data. PATIENTS AND METHODS: A review of our database identified 103 patients with surgically resectable (≤cT4acN0 cM0) MPBC who underwent RC. Survival estimates were calculated using Kaplan-Meier method and compared using log-rank tests...
May 2017: BJU International
Robert Rosenblatt, Markus Johansson, Farhood Alamdari, Alexander Sidiki, Benny Holmström, Johan Hansson, Janos Vasko, Per Marits, Susanne Gabrielsson, Katrine Riklund, Ola Winqvist, Amir Sherif
PURPOSE: To determine whether sentinel node detection (SNd) in muscle-invasive urothelial bladder cancer (MIBC) can be performed in patients undergoing neoadjuvant chemotherapy (NAC) and determine whether SNd is feasible in all pT stages, including pT0. BACKGROUND: Previous published series of SNd in MIBC have not included patients undergoing NAC, and systematic reports of pT0 patients w/wo NAC were absent. Translational immunological tumor research on MIBC focusing on SNd, in the era of NAC, requires technical feasibility...
June 2017: World Journal of Urology
Aaron Brant, Max Kates, Meera R Chappidi, Hiten D Patel, Nikolai A Sopko, George J Netto, Alex S Baras, Noah M Hahn, Phillip M Pierorazio, Trinity J Bivalacqua
PURPOSE: We estimated the proportion of patients who received neoadjuvant chemotherapy for muscle-invasive bladder cancer whose tumors were downstaged by transurethral resection. MATERIALS AND METHODS: We identified patients with cT2 N0 urothelial carcinoma who underwent cystectomy at our institution from 2005 to 2014-overall, 139 underwent transurethral resection without chemotherapy, and 146 underwent transurethral resection with chemotherapy. Pathologic response was defined as<pT2 N0...
January 2017: Urologic Oncology
Marco Moschini, Francesco Soria, Tobias Klatte, Gregory J Wirth, Mehmet Özsoy, Killian Gust, Alberto Briganti, Morgan Roupret, Martin Susani, Andrea Haitel, Shahrokh F Shariat
INTRODUCTION: The aim of this study was to validate the value of preoperative patient characteristics in prognosticating survival after radical cystectomy (RC) to guide treatment decisions regarding neoadjuvant systemic treatment. METHODS: We evaluated a single cohort of 449 consecutive patients treated with RC for bladder cancer. Patients treated with neoadjuvant therapy were excluded from the study cohort (n = 24). Patients were stratified based on preoperative characteristics into 2 risk groups...
April 2017: Clinical Genitourinary Cancer
Oscar Buisan, Anna Orsola, Joan Areal, Albert Font, Mario Oliveira, Roberto Martinez, Luis Ibarz
PURPOSE: The pretreatment neutrophil-to-lymphocyte ratio (NLR) has been associated with cancer prognosis, influencing progression and chemosensitivity. We aimed to define the role of the NLR in predicting the outcomes to neoadjuvant chemotherapy (NAC) in patients with muscle invasive bladder cancer (MIBC). PATIENTS AND METHODS: The data from patients treated with NAC and radical cystectomy for MIBC from 2007 to 2015 at a tertiary care center were reviewed. The clinicopathologic pretreatment, including the NLR, and post-treatment predictors were documented...
February 2017: Clinical Genitourinary Cancer
Antti P Salminen, Ivan Jambor, Kari T Syvanen, Peter J Bostrom
Staging of muscle-invasive bladder cancer (MIBC) remains a challenge. It is generally acknowledged that the most commonly used imaging techniques have a trend to either upstage or downstage the disease. The aim of this review article is to evaluate the currently available scientific evidence for the use of imaging modalities in preoperative bladder cancer staging with special attention to the detection of lymph node metastasis (LNM). A non-systematic literature search utilizing PubMed database with terms MIBC and LN and MRI or PET or CT was performed with the search limited to articles published between 2010 and 2015...
April 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
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