DOI QR코드

DOI QR Code

Comparison of Radical Cystectomy and Chemoradiotherapy in Patients with Locally Advanced Bladder Cancer

  • Ikeda, Masaomi (Department of Urology, Kitasato University School of Medicine) ;
  • Matsumoto, Kazumasa (Department of Urology, Kitasato University School of Medicine) ;
  • Nishi, Morihiro (Department of Urology, Kitasato University School of Medicine) ;
  • Tabata, Ken-Ichi (Department of Urology, Kitasato University School of Medicine) ;
  • Fujita, Tetsuo (Department of Urology, Kitasato University School of Medicine) ;
  • Ishiyama, Hiromichi (Department of Radiology and Radiation Oncology, Kitasato University School of Medicine) ;
  • Hayakawa, Kazushige (Department of Radiology and Radiation Oncology, Kitasato University School of Medicine) ;
  • Iwamura, Masatsugu (Department of Urology, Kitasato University School of Medicine)
  • Published : 2014.08.30

Abstract

The aim of this study was to evaluate the clinical outcomes of radical cystectomy (RC) and concurrent chemoradiotherapy (CRT) with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with locally advanced bladder cancer (BC). From December 2000 to February 2012, 72 patients with locally advanced BC (T3-4a, N0 or N+, M0) received either RC or CRT. RC with bilateral pelvic lymph node dissection including the common iliac region as the standard procedure. Patients in the CRT group received one cycle of MVAC followed by radiotherapy with a half dose of MVAC and then two more cycles of MVAC. Standard fractionation at a daily dose of 1.8-2.0 Gy was used, with a median total dose of 50 Gy (range, 45-60 Gy). The 3-year progression-free survival (PFS) rates in the RC and CRT groups were 56.2% and 25.6%, respectively (p=-0.015) and the 3-year overall survival (OS) rates were 63.5% and 48.1% (p=0.272). Multivariate Cox proportional hazards regression analysis with application of a propensity score indicated that RC was a significant predictor of PFS (p=0.033) but not of OS (p=0.291). Among patients with locally advanced BC, PFS was significantly prolonged in the RC group compared with the CRT group. However, RC was not a significant predictor of OS. Although the sample size in this study was small, the results suggest that patient background and postoperative quality of life should be considered when choosing treatment strategy for locally advanced BC.

Keywords

References

  1. Baykara M, Buyukberber S, Ozturk B, et al (2013). Efficacy and safety of concomitant chemoradiotherapy with cisplatin and docetaxel in patients with locally advanced squamous cell head and neck cancers. Asian Pac J Cancer Prev, 14, 2557-61. https://doi.org/10.7314/APJCP.2013.14.4.2557
  2. Borut K, Lijana ZK (2012). Phase I study of radiochemotherapy with gemcitabine in invasive bladder cancer. Radiother Oncol, 102, 412-5. https://doi.org/10.1016/j.radonc.2011.07.026
  3. Caffo O, Fellin G, Graffer U, et al (2003). Phase I study of gemcitabine and radiotherapy plus cisplatin after transurethral resection as conservative treatment for infiltrating bladder cancer. Int J Radiat Oncol Biol Phys, 57, 1310-6. https://doi.org/10.1016/S0360-3016(03)00763-6
  4. Cepeda MS, Boston R, Farrar JT, Strom BL (2003). Comparison of logistic regression versus propensity score when the number of events is low and there are multiple confounders. Am J Epidemiol, 158, 280-7. https://doi.org/10.1093/aje/kwg115
  5. Coppin CM, Gospodarowicz MK, James K, et al (1996). Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol, 14, 2901-7.
  6. Efstathiou JA, Spiegel DY, Shipley WU, et al (2012). Long-term outcomes of selective bladder preservation by combinedmodality therapy for invasive bladder cancer: the MGH experience. Eur Urol, 61, 705-11. https://doi.org/10.1016/j.eururo.2011.11.010
  7. Grossman HB, Natale RB, Tangen CM, et al (2003). Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med, 349, 859-66. https://doi.org/10.1056/NEJMoa022148
  8. Hashemi FA, Akbari EH, Kalaghchi B, Esmati E (2013). Concurrent chemoradiation with weekly gemcitabine and cisplatin for locally advanced cervical cancer. Asian Pac J Cancer Prev, 14, 5385-9. https://doi.org/10.7314/APJCP.2013.14.9.5385
  9. Hautmann RE, Gschwend JE, de Petriconi RC, Kron M, Volkmer BG (2006). Cystectomy for transitional cell carcinoma of the bladder: results of a surgery only series in the neobladder era. J Urol, 176, 486-92. https://doi.org/10.1016/j.juro.2006.03.038
  10. Hautmann RE, de Petriconi RC, Volkmer BG (2010). Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol, 184, 990-4. https://doi.org/10.1016/j.juro.2010.05.037
  11. Hautmann RE, de Petriconi RC, Pfeiffer C, Volkmer BG (2012). Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol, 61, 1039-47. https://doi.org/10.1016/j.eururo.2012.02.028
  12. Huddart RA, Hall E, Lewis R, Birtle A (2010). Life and death of spare (selective bladder preservation against radical excision): reflections on why the spare trial closed. BJU Int, 106, 753-5. https://doi.org/10.1111/j.1464-410X.2010.09537.x
  13. Ikeda M, Matsumoto K, Niibe Y, et al (2011). The radiotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin treatment is an effective therapeutic option in patients with advanced or metastatic bladder cancer. J Radiat Res, 52, 674-9. https://doi.org/10.1269/jrr.11036
  14. Ikeda M, Matsumoto K, Tabata K, et al (2011). Combination of gemcitabine and paclitaxel is a favorable option for patients with advanced or metastatic urothelial carcinoma previously treated with cisplatin-based chemotherapy. Jpn J Clin Oncol, 41, 1214-20. https://doi.org/10.1093/jjco/hyr131
  15. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  16. James ND, Hussain SA, Hall E, et al (2012). Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med, 366, 1477-88. https://doi.org/10.1056/NEJMoa1106106
  17. Kachnic LA, Kaufman DS, Heney NM, et al (1997). Bladder preservation by combined modality therapy for invasive bladder cancer. J Clin Oncol, 15, 1022-9.
  18. Kaufman DS, Winter KA, Shipley WU, et al (2009). Phase I-II RTOG study (99-06) of patients with muscle-invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice-daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology, 73, 833-7. https://doi.org/10.1016/j.urology.2008.09.036
  19. Kilic D, Yalman D, Aksu G, et al (2012). Impact of adjuvant chemoradiotherapy for rectal cancer on the long-term quality of life and late side effects: a multicentric clinical evaluation by the Turkish Oncology Group. Asian Pac J Cancer Prev, 13, 5741-6. https://doi.org/10.7314/APJCP.2012.13.11.5741
  20. Liang ZG, Zhu XD, Tan AH, et al (2013). Induction chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma: meta-analysis of 1,096 patients from 11 randomized controlled trials. Asian Pac J Cancer Prev, 14, 515-21. https://doi.org/10.7314/APJCP.2013.14.1.515
  21. Madersbacher S, Hochreiter W, Burkhard F, et al (2003). Radical cystectomy for bladder cancer today - a homogeneous series without neoadjuvant therapy. J Clin Oncol, 21, 690-6. https://doi.org/10.1200/JCO.2003.05.101
  22. Nishiyama H, Habuchi T, Watanabe J, et al (2004). Clinical outcome of a large-scale multi-institutional retrospective study for locally advanced bladder cancer: a survey including 1131 patients treated during 1990-2000 in Japan. Eur Urol, 45, 176-81. https://doi.org/10.1016/j.eururo.2003.09.011
  23. Novara G, De Marco V, Aragona M, et al (2009). Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol, 182, 914-21. https://doi.org/10.1016/j.juro.2009.05.032
  24. Oh KS, Soto DE, Smith DC, et al (2009). Combined-modality therapy with gemcitabine and radiation therapy as a bladder preservation strategy: long-term results of a phase I trial. Int J Radiat Oncol Biol Phys, 74, 511-7. https://doi.org/10.1016/j.ijrobp.2008.08.021
  25. Paramasivan S, Huddart R, Hall E, et al (2011). Key issues in recruitment to randomised controlled trials with very different interventions: a qualitative investigation of recruitment to the SPARE trial (CRUK/07/011). Trials, 12, 78. https://doi.org/10.1186/1745-6215-12-78
  26. Rodel C, Grabenbauer GG, Kuhn R, et al (2002). Combinedmodality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol, 20, 3061-71. https://doi.org/10.1200/JCO.2002.11.027
  27. Shipley WU, Prout GR, Jr Einstein AB, et al (1987). Treatment of invasive bladder cancer by cisplatin and radiation in patients unsuited for surgery. JAMA, 258, 931-5. https://doi.org/10.1001/jama.1987.03400070069037
  28. Shipley WU, Winter KA, Kaufman DS, et al (1998). Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol, 16, 3576-83.
  29. Stein JP, Lieskovsky G, Cote R, et al (2001). Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol, 19, 666-75.
  30. Sternberg CN, Yagoda A, Scher HI, et al (1985). Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium. J Urol, 133, 403-7.
  31. Teramukai S, Nishiyama H, Matsui Y, Ogawa O, Fukushima M (2006). Evaluation for surrogacy of end points by using data from observational studies: tumor downstaging for evaluating neoadjuvant chemotherapy in invasive bladder cancer. Clin Cancer Res. 12, 139-43. https://doi.org/10.1158/1078-0432.CCR-05-1598
  32. von der Maase H, Hansen SW, Roberts JT, et al (2000). Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol, 18, 3068-77.
  33. Yu HS, Wang X, Song AQ, et al (2012). Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma. Asian Pac J Cancer Prev. 13, 3961-5. https://doi.org/10.7314/APJCP.2012.13.8.3961

Cited by

  1. High Expression Level of Preoperative Serum Uroplakin III is Associated with Biologically Aggressive Bladder Cancer vol.16, pp.4, 2015, https://doi.org/10.7314/APJCP.2015.16.4.1539
  2. Gemcitabine Plus Nedaplatin as Salvage Therapy is a Favorable Option for Patients with Progressive Metastatic Urothelial Carcinoma After Two Lines of Chemotherapy vol.16, pp.6, 2015, https://doi.org/10.7314/APJCP.2015.16.6.2483
  3. Predictive Effect of Preoperative Anemia on Long-Term Survival Outcomes with Non-Muscle Invasive Bladder Cancer vol.17, pp.4, 2016, https://doi.org/10.7314/APJCP.2016.17.4.1755