Comparison of Neoadjuvant Chemotherapy and Bladder-Preserving Chemoradiation in Patients with Non-Metastatic, Muscle-Invasive Bladder Cancer: A Single-Center Experience
Received Date : 20 Jun 2020
Accepted Date : 13 Sep 2020
Available Online : 16 Oct 2020
Ali GÖKYERa, Ahmet KÜÇÜKARDAa, Osman KÖSTEKa, Muhammet Bekir HACIOĞLUa, Kubilay İŞSEVERb, Talar ÖZLERc, Gökhan ÇEVİKd, Sernaz UZUNOĞLUa, Bülent ERDOĞANa, İrfan ÇİÇİNa
aDivision of Medical Oncology, Trakya University Faculty of Medicine, Edirne, TURKEY
bDepartment of Internal Medicine, Sakarya University Facutly of Medicine, Sakarya, TURKEY
cDepartment of Radiation Oncology, Trakya University Faculty of Medicine, Edirne, TURKEY
dDepartment of Urology, Trakya University Faculty of Medicine, Edirne, TURKEY
Doi: 10.37047/jos.2020-77532 - Article's Language: EN
J Oncol Sci. 2020;6(3):141-6
ABSTRACT
Objective: Approaches for curative treatment of muscle-invasive bladder cancer include radical cystectomy after neoadjuvant
chemotherapy and chemoradiotherapy. We compared the results of these treatment modalities in our clinic. Material and Methods: A total
of 43 patients with muscle-invasive bladder cancer, who underwent front-line cystectomy or received neoadjuvant chemoradiotherapy between
2010 and 2018, were compared retrospectively. Results: Twenty patients received definitive chemoradiotherapy, and 23 patients underwent
surgery (cystectomy) after neoadjuvant treatment. The median age was 68 years, and 86% of the patients were male. The median age was higher
in the chemoradiotherapy group, and the number of patients with an ECOG performance score above 2 was significantly higher in this group.
In patients who underwent surgery after neoadjuvant treatment, median disease-free survival was 17.1 months (CI: 6.1-27.9) and overall survival
(OS) was 22.2 months (CI: 10.3-34.1), whereas disease-free survival was 12.5 months (CI: 9.7-15.3) (p=0.93). The OS was 12.7 months
(CI:1.0-33.9) (p=0.74) in the group receiving definitive chemoradiotherapy. Survival was significantly longer (p=0.03) in patients who were
treated with radical cystectomy, and pathological downstaging (T1 tumor and below) was achieved. In addition, the male gender, smoking
above 40 pack-years, and alcohol remarkably reduced the OS. Conclusion: The OS and disease-free survival were similar between patients
in the chemoradiotherapy and surgery groups. In contrast, patients with ECOG performance score below 2 and pathological downstaging
after neoadjuvant chemotherapy had prolonged survival.
Keywords: Urinary bladder neoplasms; chemoradiotherapy; cystectomy