PURPOSE: We describe the clinical course of patients who achieved cT0 status after neoadjuvant chemotherapy for muscle invasive bladder cancer. There is no established treatment paradigm for these patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 109 patients with muscle invasive bladder cancer (T2 or greater urothelial carcinoma of the bladder) who underwent platinum based neoadjuvant chemotherapy at our institution from 1988 to 2012. Post-chemotherapy assessment of the response included cytology, cystoscopy with biopsy and cross-sectional imaging. RESULTS: Of 109 patients 32 (29.4%) achieved cT0 status after neoadjuvant chemotherapy. Mean ± SD age of the cohort was 68.3 ± 9.6 years. Of the patients 21 received MVAC, 8 received gemcitabine and cisplatin, and 3 received another regimen. Seven complete responders elected immediate radical cystectomy after the completion of neoadjuvant chemotherapy. Of 25 patients who refused radical cystectomy after achieving cT0 status 7 experienced relapse after the completion of neoadjuvant chemotherapy and proceeded to radical cystectomy. The remaining 18 patients (72%) retained the bladder, including 6 (18.8% of the cohort) in whom nonmuscle invasive relapses were managed conservatively and 12 (37.5%) with no recurrence. In the 25 patients who elected bladder preservation after achieving cT0 status following neoadjuvant chemotherapy 5-year cancer specific survival was 88%. CONCLUSIONS: With proper counseling and identification of treatment goals patients with cT0 after neoadjuvant chemotherapy for muscle invasive bladder cancer may have the option to retain the bladder with durable survival. Larger studies are needed to identify possible predictors of response on the clinical, pathological and molecular levels.
PURPOSE: We describe the clinical course of patients who achieved cT0 status after neoadjuvant chemotherapy for muscle invasive bladder cancer. There is no established treatment paradigm for these patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 109 patients with muscle invasive bladder cancer (T2 or greater urothelial carcinoma of the bladder) who underwent platinum based neoadjuvant chemotherapy at our institution from 1988 to 2012. Post-chemotherapy assessment of the response included cytology, cystoscopy with biopsy and cross-sectional imaging. RESULTS: Of 109 patients 32 (29.4%) achieved cT0 status after neoadjuvant chemotherapy. Mean ± SD age of the cohort was 68.3 ± 9.6 years. Of the patients 21 received MVAC, 8 received gemcitabine and cisplatin, and 3 received another regimen. Seven complete responders elected immediate radical cystectomy after the completion of neoadjuvant chemotherapy. Of 25 patients who refused radical cystectomy after achieving cT0 status 7 experienced relapse after the completion of neoadjuvant chemotherapy and proceeded to radical cystectomy. The remaining 18 patients (72%) retained the bladder, including 6 (18.8% of the cohort) in whom nonmuscle invasive relapses were managed conservatively and 12 (37.5%) with no recurrence. In the 25 patients who elected bladder preservation after achieving cT0 status following neoadjuvant chemotherapy 5-year cancer specific survival was 88%. CONCLUSIONS: With proper counseling and identification of treatment goals patients with cT0 after neoadjuvant chemotherapy for muscle invasive bladder cancer may have the option to retain the bladder with durable survival. Larger studies are needed to identify possible predictors of response on the clinical, pathological and molecular levels.
Authors: Patrick Mazza; George W Moran; Gen Li; Dennis J Robins; Justin T Matulay; Harry W Herr; Guarionex J Decastro; James M McKiernan; Christopher B Anderson Journal: J Urol Date: 2018-05-19 Impact factor: 7.450
Authors: William P Parker; Philip L Ho; Stephen A Boorjian; Jonathan J Melquist; Prabin Thapa; Jeffrey M Holzbeierlein; Igor Frank; Ashish M Kamat; Eugene K Lee Journal: World J Urol Date: 2016-03-04 Impact factor: 4.226
Authors: 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 Journal: J Clin Oncol Date: 2018-05-09 Impact factor: 44.544
Authors: Michael L Stromyer; Marie R Southerland; Uttam Satyal; Rahmat K Sikder; David J Weader; Jessi A Baughman; Wiley J Youngs; Philip H Abbosh Journal: Eur J Med Chem Date: 2019-10-31 Impact factor: 7.088