Long-Term Outcomes Among Patients Who Achieve Complete or Near-Complete Responses After the Induction Phase of Bladder-Preserving Combined-Modality Therapy for Muscle-Invasive Bladder Cancer: A Pooled Analysis of NRG Oncology/RTOG 9906 and 0233.

Szczegóły
Abstrakt

Tytuł:: Long-Term Outcomes Among Patients Who Achieve Complete or Near-Complete Responses After the Induction Phase of Bladder-Preserving Combined-Modality Therapy for Muscle-Invasive Bladder Cancer: A Pooled Analysis of NRG Oncology/RTOG 9906 and 0233.
Autorzy:: Mitin T; Oregon Health & Science University, Portland, Oregon. Electronic address: .
George A; NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
Zietman AL; Massachusetts General Hospital, Boston, Massachusetts.
Heney NM; Massachusetts General Hospital, Boston, Massachusetts.
Kaufman DS; Massachusetts General Hospital, Boston, Massachusetts.
Uzzo RG; Fox Chase Cancer Center, Philadelphia, Pennsylvania.
Dreicer R; University of Virginia, Charlottesville, Virginia.
Wallace HJ 3rd; University of Vermont College of Medicine, Burlington, Vermont.
Souhami L; McGill University Health Centre, Montreal, Québec, Canada.
Dobelbower MC; University of Alabama at Birmingham, Birmingham, Alabama.
Sandler HM; Cedars-Sinai Medical Center, Los Angeles, California.
Shipley WU; Massachusetts General Hospital, Boston, Massachusetts.
Źródło:: International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2016 Jan 01; Vol. 94 (1), pp. 67-74. Date of Electronic Publication: 2015 Sep 28.
Typ publikacji:: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: New York, NY : Elsevier, Inc
Original Publication: Elmsford, N. Y., Pergamon Press.
MeSH Terms:: Carcinoma, Transitional Cell/*therapy
Chemoradiotherapy/*methods
Consolidation Chemotherapy/*methods
Organ Sparing Treatments/*methods
Urinary Bladder Neoplasms/*therapy
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Carcinoma, Transitional Cell/pathology ; Cisplatin/administration & dosage ; Combined Modality Therapy/methods ; Cystectomy ; Deoxycytidine/administration & dosage ; Deoxycytidine/analogs & derivatives ; Female ; Fluorouracil/administration & dosage ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/surgery ; Paclitaxel/administration & dosage ; Prospective Studies ; Radiotherapy Dosage ; Remission Induction ; Salvage Therapy/methods ; Urinary Bladder Neoplasms/mortality ; Urinary Bladder Neoplasms/pathology ; Gemcitabine
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Grant Information:: U10 CA180868 United States CA NCI NIH HHS; UG1 CA189867 United States CA NCI NIH HHS; U10CA180822 United States CA NCI NIH HHS; U10CA37422 United States CA NCI NIH HHS; U10 CA037422 United States CA NCI NIH HHS; U10 CA021661 United States CA NCI NIH HHS; U10 CA180855 United States CA NCI NIH HHS; U10CA180868 United States CA NCI NIH HHS; U10CA21661 United States CA NCI NIH HHS; U10 CA180822 United States CA NCI NIH HHS
Substance Nomenclature:: 0W860991D6 (Deoxycytidine)
P88XT4IS4D (Paclitaxel)
Q20Q21Q62J (Cisplatin)
U3P01618RT (Fluorouracil)
0 (Gemcitabine)
Entry Date(s):: Date Created: 20151225 Date Completed: 20160427 Latest Revision: 20221207
Update Code:: 20240104
PubMed Central ID:: PMC4690848
DOI:: 10.1016/j.ijrobp.2015.09.030
PMID:: 26700703
: Czasopismo naukowe

Purpose: To investigate the differences in outcomes among patients with muscle-invasive bladder cancer on NRG Oncology Radiation Therapy Oncology Group protocols 9906 and 0233 who achieved complete response and near-complete response after induction chemoradiation and then completed bladder-preserving therapy with chemoradiation therapy (chemo-RT) to full dose (60-64 Gy).
Patients and Methods: A pooled analysis was performed on 119 eligible patients with muscle-invasive bladder cancer enrolled on NRG Oncology Radiation Therapy Oncology Group trials 9906 and 0233, who were classified as having a complete (T0) or near-complete (Ta or Tis) response after induction chemo-RT and completed consolidation with a total RT dose of at least 60 Gy. Bladder recurrence, salvage cystectomy rates, and disease-specific survival were estimated by the cumulative incidence method and bladder-intact and overall survivals by the Kaplan-Meier method.
Results: Among the 119 eligible patients, 101 (85%) achieved T0, and 18 (15%) achieved Ta or Tis after induction chemo-RT and proceeded to consolidation. After a median follow-up of 5.9 years, 36 of 101 T0 patients (36%) versus 5 of 18 Ta or Tis patients (28%) experienced bladder recurrence (P=.52). Thirteen patients among complete responders eventually required late salvage cystectomy for tumor recurrence, compared with 1 patient among near-complete responders (P=.63). Disease-specific, bladder-intact, and overall survivals were not significantly different between T0 and Ta/Tis cases.
Conclusions: The bladder recurrence and salvage cystectomy rates of the complete and the near-complete responders were similar. Therefore it is reasonable to recommend that patients with Ta or Tis after induction chemo-RT continue with bladder-sparing therapy with consolidation chemo-RT to full dose (60-64 Gy).
(Copyright © 2016 Elsevier Inc. All rights reserved.)

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