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2 Localised invasive bladder cancer: Surgery
Invited abstracts / Critical Reviews in Oncology/Hematology 78 S1 (2011) S1−S20
survival after radical cystectomy and 3 adjuvant cycles of chemotherapy. Results of a controlled prospective study. J Urol. 1992;148:302−6; discussion 306−7. [14] Skinner DG, Daniels JR, Russell CA, et al. The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial. J Urol. 1991;145:459−64; discussion 464−7. [15] Studer UE, Bacchi M, Biedermann C, et al. Adjuvant cisplatin chemotherapy following cystectomy for bladder cancer: results of a prospective randomized trial. J Urol. 1994;152:81−4. [16] Freiha F, Reese J, Torti FM. A randomized trial of radical cystectomy versus radical cystectomy plus cisplatin, vinblastine and methotrexate chemotherapy for muscle invasive bladder cancer. J Urol. 1996;155:495−9; discussion 499–500.
2 Localised invasive bladder cancer: Surgery G.N. Thalmann1 *. 1 University of Berne, Department of Urology, Berne, Switzerland Radical surgical treatment remains the gold standard in the treatment of locally invasive bladder cancer. With few exceptions radical cystectomy is the surgical treatment of choice. The outcome of radical cystectomy depends first and mostly on good surgical technique, with removal of the primary tumour with a margin of healthy tissue around the tumour, and on a meticulous extended pelvic lymph node dissection. Open radical cystectomy remains the best approach to fulfil these criteria, minimal invasive approaches are currently being evaluated but for the time must be considered experimental. Factors such as tumour stage and extension, lymph node involvement and extranodal growth of lymph node metastases, but also LVI of the primary tumour, a delay in time to surgery, age and comorbidities have an impact on survival after radical cystectomy. The use of neo-adjuvant chemotherapy must be weighed against immediate surgical treatment, as for patients not responding to neo-adjuvant chemotherapy critical time may be lost in patients otherwise resectable and potentially curable. 3 The role of radiotherapy in muscle invasive bladder cancer N. James1 *. 1 University of Birmingham, School of Cancer Sciences, Birmingham, UK Bladder cancer, with over 350,000 new cases in 2009, is a major cause of cancer death worldwide, and is rapidly rising in incidence in countries such as China. As the tumour is smoking-related, many patients are elderly with significant co-morbidity, posing a considerable risk for radical surgical approaches. Survival rates are poor, with only around 45% of muscle-invasive cancer patients surviving five years. Invasive disease either involves surgical management or radical radiotherapy. Although surgery is considered the standard therapy worldwide, there is considerable interest in bladder preservation as an alternative, particularly in
S3
patients less suitable for radical surgery, especially as mortality is predominantly related to metastatic spread rather than failure to achieve local control. Radical radiotherapy with salvage cystectomy has commonly been used as an alternative for those unfit for surgery, especially in the United Kingdom (UK). However, radiotherapy as sole treatment modality suffers from a relatively high rate of incomplete response or local recurrence (up to 50%). There is increasing evidence that radio-sensitising treatments can improve outcomes in bladder preservation, with two recent positive randomised trials adding to the previous single study from the National Cancer institute of Canada (NCIC) study published in 1996. This study randomised 99 patients to receive radiotherapy with or without cisplatin and showed significant improvements in pelvic progression-free survival. The study was however small and not adequately powered to demonstrate a survival benefit. In addition it used “North American” style radiotherapy with a split course and interval cystoscopy rather than the UK method of delivering the complete course of treatment with subsequent cystoscopic assessment. The recently completed UK BCON trial compared radiotherapy alone with radiotherapy plus nicotinamide and carbogen radio-sensitisers and showed an overall survival (OS) advantage (hazard ratio [HR] = 0.86, 95% confidence interval [CI]: 0.74–1.00; p = 0.04) for combined therapy, but surprisingly failed to show a statistically significant improvement in locoregional or disease-free survival. In parallel, the BC2001 trial tested the hypothesis that synchronous chemo-radiotherapy with 5-fluorouracil and mitomycin C (5-FU/MMC) was more efficacious than radiotherapy alone in 360 pateints with locally advanced disease. The patients were relatively old (median age 72.9 (IQR 65.5–77.6) years compared to typical surgical series and also the previous NCIC trial (median 65 years). The study demonstrated a significant reduction in locoregional recurrence (0.67 (95 CI: 0.47, 0.95); p = 0.03), with as yet immature survival data. The growing role for bladder preservation using synchronous radio-sensitisation will be discussed in the presentation.
Palliative chemotherapy: First-line, second-line, platinum-unfit 4 Treating bladder cancer: first-line, second-line, platinum-unfit M. De Santis1,2,3 *. 1 Kaiser Franz Josef-Hospital and ACR-ITR VIEnna/CEADDP and LBI-ACR VIEnna-CTO, Vienna, 2 3rd Medical Department, Center for Oncology and Hematology, 3 Kaiser Franz Josef-Hospital, SMZ S¨ud, Vienna, Austria Cisplatin-containing combination chemotherapy (CHT) has been the standard of care in the treatment of urothelial cancer
survival after radical cystectomy and 3 adjuvant cycles of chemotherapy. Results of a controlled prospective study. J Urol. 1992;148:302−6; discussion 306−7. [14] Skinner DG, Daniels JR, Russell CA, et al. The role of adjuvant chemotherapy following cystectomy for invasive bladder cancer: a prospective comparative trial. J Urol. 1991;145:459−64; discussion 464−7. [15] Studer UE, Bacchi M, Biedermann C, et al. Adjuvant cisplatin chemotherapy following cystectomy for bladder cancer: results of a prospective randomized trial. J Urol. 1994;152:81−4. [16] Freiha F, Reese J, Torti FM. A randomized trial of radical cystectomy versus radical cystectomy plus cisplatin, vinblastine and methotrexate chemotherapy for muscle invasive bladder cancer. J Urol. 1996;155:495−9; discussion 499–500.
2 Localised invasive bladder cancer: Surgery G.N. Thalmann1 *. 1 University of Berne, Department of Urology, Berne, Switzerland Radical surgical treatment remains the gold standard in the treatment of locally invasive bladder cancer. With few exceptions radical cystectomy is the surgical treatment of choice. The outcome of radical cystectomy depends first and mostly on good surgical technique, with removal of the primary tumour with a margin of healthy tissue around the tumour, and on a meticulous extended pelvic lymph node dissection. Open radical cystectomy remains the best approach to fulfil these criteria, minimal invasive approaches are currently being evaluated but for the time must be considered experimental. Factors such as tumour stage and extension, lymph node involvement and extranodal growth of lymph node metastases, but also LVI of the primary tumour, a delay in time to surgery, age and comorbidities have an impact on survival after radical cystectomy. The use of neo-adjuvant chemotherapy must be weighed against immediate surgical treatment, as for patients not responding to neo-adjuvant chemotherapy critical time may be lost in patients otherwise resectable and potentially curable. 3 The role of radiotherapy in muscle invasive bladder cancer N. James1 *. 1 University of Birmingham, School of Cancer Sciences, Birmingham, UK Bladder cancer, with over 350,000 new cases in 2009, is a major cause of cancer death worldwide, and is rapidly rising in incidence in countries such as China. As the tumour is smoking-related, many patients are elderly with significant co-morbidity, posing a considerable risk for radical surgical approaches. Survival rates are poor, with only around 45% of muscle-invasive cancer patients surviving five years. Invasive disease either involves surgical management or radical radiotherapy. Although surgery is considered the standard therapy worldwide, there is considerable interest in bladder preservation as an alternative, particularly in
S3
patients less suitable for radical surgery, especially as mortality is predominantly related to metastatic spread rather than failure to achieve local control. Radical radiotherapy with salvage cystectomy has commonly been used as an alternative for those unfit for surgery, especially in the United Kingdom (UK). However, radiotherapy as sole treatment modality suffers from a relatively high rate of incomplete response or local recurrence (up to 50%). There is increasing evidence that radio-sensitising treatments can improve outcomes in bladder preservation, with two recent positive randomised trials adding to the previous single study from the National Cancer institute of Canada (NCIC) study published in 1996. This study randomised 99 patients to receive radiotherapy with or without cisplatin and showed significant improvements in pelvic progression-free survival. The study was however small and not adequately powered to demonstrate a survival benefit. In addition it used “North American” style radiotherapy with a split course and interval cystoscopy rather than the UK method of delivering the complete course of treatment with subsequent cystoscopic assessment. The recently completed UK BCON trial compared radiotherapy alone with radiotherapy plus nicotinamide and carbogen radio-sensitisers and showed an overall survival (OS) advantage (hazard ratio [HR] = 0.86, 95% confidence interval [CI]: 0.74–1.00; p = 0.04) for combined therapy, but surprisingly failed to show a statistically significant improvement in locoregional or disease-free survival. In parallel, the BC2001 trial tested the hypothesis that synchronous chemo-radiotherapy with 5-fluorouracil and mitomycin C (5-FU/MMC) was more efficacious than radiotherapy alone in 360 pateints with locally advanced disease. The patients were relatively old (median age 72.9 (IQR 65.5–77.6) years compared to typical surgical series and also the previous NCIC trial (median 65 years). The study demonstrated a significant reduction in locoregional recurrence (0.67 (95 CI: 0.47, 0.95); p = 0.03), with as yet immature survival data. The growing role for bladder preservation using synchronous radio-sensitisation will be discussed in the presentation.
Palliative chemotherapy: First-line, second-line, platinum-unfit 4 Treating bladder cancer: first-line, second-line, platinum-unfit M. De Santis1,2,3 *. 1 Kaiser Franz Josef-Hospital and ACR-ITR VIEnna/CEADDP and LBI-ACR VIEnna-CTO, Vienna, 2 3rd Medical Department, Center for Oncology and Hematology, 3 Kaiser Franz Josef-Hospital, SMZ S¨ud, Vienna, Austria Cisplatin-containing combination chemotherapy (CHT) has been the standard of care in the treatment of urothelial cancer