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
Doi: 10.37047/jos.2020-77532 - Article's Language: EN
J Oncol Sci. 2020;6(3):141-6
This is an open access article under the CC BY-NC-ND license
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.
  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018;68(1):7-30. [Crossref]  [PubMed] 
  2. Howlader N, Noone A, Krapcho M, Miller D, Bishop K, Kosary C, et al. SEER Cancer Statistics Review, 1975-2014, National Cancer Institute. Bethesda, MD. Based on November 2016 SEER data submission, posted to the SEER web site, April 2017.
  3. Gallagher DJ, Milowsky MI. Bladder cancer. Curr Treat Options Oncol. 2009;10(3-4):205-15. [Crossref]  [PubMed] 
  4. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1.054 patients. J Clin Oncol. 2001;19(3):666-75. [Crossref]  [PubMed] 
  5. Skinner DG, Lieskovsky G. Contemporary cystectomy with pelvic node dissection compared to preoperative radiation therapy plus cystectomy in management of invasive bladder cancer. J Urol. 1984;131(6):1069-72. [Crossref]  [PubMed] 
  6. Smith JA Jr, Crawford ED, Paradelo JC, B Blumenstein, B R Herschman, H B Grossman et al. Treatment of advanced bladder cancer with combined preoperative irradiation and radical cystectomy versus radical cystectomy alone: a phase III intergroup study. J Urol. 1997;157(3):805-7. [Crossref]  [PubMed] 
  7. Vale CL. Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data: Advanced Bladder Cancer (ABC) Metaanalysis Collaboration. Eur Urol. 2005;48(2):202-6. [Crossref]  [PubMed] 
  8. Fernando SA, Sandler HM. Multimodality bladder preservation therapy for muscle-invasive bladder tumors. Semin Oncol. 2007;34(2):129-34. [Crossref]  [PubMed] 
  9. Kotwal S, Choudhury A, Johnston C, Alan B Paul, Peter Whelan, Anne E Kiltie. Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom Specialist Treatment Center. Int J Radiat Oncol Biol Phys. 2008;70(2):456-63. [Crossref]  [PubMed] 
  10. Munro NP, Sundaram SK, Weston PMT. A 10-year retrospective review of a non-randomized cohort of 458 patients undergoing radical radiotherapy or cystectomy in Yorkshire, UK. Int J Radiat Oncol Biol Phys. 2010;77(1):119-24. [Crossref]  [PubMed] 
  11. Booth CM, Siemens DR, Li G. Curative therapy for bladder cancer in routine clinical practice: a population-based outcomes study. Clin Oncol. 2014;26(8):506-14. [Crossref]  [PubMed] 
  12. Arcangeli G, Strigari L, Arcangeli S. Radical cystectomy versus organ-sparing trimodality treatment in muscle-invasive bladder cancer: a systematic review of clinical trials. Crit Rev Oncol Hematol. 2015;95(3):387-9. [Crossref]  [PubMed] 
  13. Ritch CR, Balise R, Prakash NS, David A, Katherine A, Mahmoud A, et al. Propensity matched comparative analysis of survival following chemoradiation or radicalcystectomy for muscle-invasive bladder cancer. BJU Int. 2018;121(5):745-51. [Crossref]  [PubMed] 
  14. Boustani J, Bertaut A, Galsky MD, Rosenberg JE, Bellmunt J, Powles T et al. Radical cystectomy or bladder preservation with radiochemotherapy in elderly patients with muscle-invasive bladder cancer: Retrospective International Study of Cancers of the Urothelial Tract (RISC) Investigators. Acta Oncol. 2018;57(4):491-7. [Crossref]  [PubMed] 
  15. Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locallyadvanced bladder cancer. N Engl J Med. 2003;349(9):859-66. [Crossref]  [PubMed] 
  16. Yin M, Joshi M, Meijer RP, Glantz M, Holder S, Harvey HA et al. Neoadjuvant chemotherapy for muscle-invasive bladder cancer: a systematic review and two-step meta-analysis. Oncologist. 2016;21(6):708-15. [Crossref]  [PubMed]  [PMC] 
  17. Buttigliero C, Tucci M, Vignani F, Scagliotti GV, Di Maio M. Molecular biomarkers to predict response to neoadjuvant chemotherapy for bladder cancer. Cancer Treat Rev. March 2017;54:1-9. [Crossref]  [PubMed] 
  18. Hong-Yiou L , Hong Y, Kenneth MK, Jason MH, Daniel JK, et al. National cancer database comparison of radical cystectomy vs chemoradiotherapy for muscle-ınvasive bladder cancer: ımplications of using clinical vs pathologic staging. Cancer Med. 2018;7(11):5370-81. [Crossref]  [PubMed]  [PMC]