Giulio Francolini1, Simona Borghesi2, Sergio Fersino3, Alessandro Magli4, Barbara Alicja Jereczek-Fossa5, Luca Cristinelli6, Mimma Rizzo7, Renzo Corvò8, Giovanni L Pappagallo9, Stefano Arcangeli10, Stefano Maria Magrini11, Rolando M D'Angelillo12. 1. Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy. 2. Radiation Oncology Arezzo-Valdarno, Azienda USL Toscana Sud Est, Arezzo, Italy. Electronic address: s.borghesi@gmail.com. 3. Radiotherapy Division, Santa Chiara Hospital, Trento, Italy. 4. Department of Radiation Oncology, Udine General Hospital, Udine, Italy. 5. Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy. 6. Urology Department, ASST Spedali Civili di Brescia, Brescia University, Italy. 7. Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy. 8. Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 9. Epidemiology & Clinical Trials Office, General Hospital, 30035, Mirano, VE, Italy. 10. Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca", Milan, Italy. 11. Radiation Oncology Department, ASST Spedali Civili di Brescia, Brescia University, Italy. 12. Department of Radiation Oncology, Policlinico Tor Vergata University, Viale Oxford, 81, 00133, Rome, Italy.
Abstract
AIM: To compare trimodality therapy (TMT) versus radical cystectomy (RC) and develop GRADE (Grades of Recommendation, Assessment, Development and Evaluation) Recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) for treatment of muscle-invasive bladder cancer (MIBC). MATERIAL AND METHODS: Prospective and retrospective studies comparing TMT and RC for MIBC patients were included. Qualitative and quantitative evaluation of evidence was made. RESULTS: Ten studies were included in the analysis. Pooled analysis showed salvage cystectomy and pathological complete response rates after TMT of 12% and 72-77.5%, respectively. Pooled rates of G3-G4 GU toxicity and serious toxicity rate were 18 vs 3% and 45 vs 29% for patients undergoing TMT vs RC, respectively. The panel assessed a substantial equivalence in terms of OS and CSS at 5 years between TMT and RC. CONCLUSIONS: TMT could be suggested as an alternative treatment to RC in non-metastatic MIBC patients, deemed fit for surgery.
AIM: To compare trimodality therapy (TMT) versus radical cystectomy (RC) and develop GRADE (Grades of Recommendation, Assessment, Development and Evaluation) Recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) for treatment of muscle-invasive bladder cancer (MIBC). MATERIAL AND METHODS: Prospective and retrospective studies comparing TMT and RC for MIBC patients were included. Qualitative and quantitative evaluation of evidence was made. RESULTS: Ten studies were included in the analysis. Pooled analysis showed salvage cystectomy and pathological complete response rates after TMT of 12% and 72-77.5%, respectively. Pooled rates of G3-G4 GUtoxicity and serious toxicity rate were 18 vs 3% and 45 vs 29% for patients undergoing TMT vs RC, respectively. The panel assessed a substantial equivalence in terms of OS and CSS at 5 years between TMT and RC. CONCLUSIONS: TMT could be suggested as an alternative treatment to RC in non-metastatic MIBC patients, deemed fit for surgery.