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Alati A, Fabiano E, Geiss R, Mareau A, Charles-Nelson A, Bibault JE, Giraud P, Kreps S, Méjean A, Housset M, Durdux C. Bladder preservation in older adults with muscle-invasive bladder cancer: A retrospective study with concurrent chemotherapy and twice-daily hypofractionated radiotherapy schedule. J Geriatr Oncol 2022; 13:978-986. [PMID: 35717533 DOI: 10.1016/j.jgo.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bladder cancer occurs mainly in older adults and surgery is not always possible when there are geriatric conditions and comorbidities. Trimodal treatment (TMT) combining trans-urethral resection of bladder tumour (TURBT) followed by concurrent chemoradiation (CRT) would be a curative alternative in such patients. METHODS All consecutive patients 75 years of age and older with non-metastatic muscle-invasive bladder cancer (MIBC) treated with TMT by Georges Pompidou European Hospital team were retrospectively analysed. Induction CRT combined hypofractionated twice-daily radiotherapy targeting bladder and pelvis to a total dose of 24 Gy (Gy) with concurrent platinum salt and 5-fluorouracil. Consolidation CRT to a total dose of 44 Gy was proposed to patients with biopsy-proven complete response after induction phase and those with persistent tumour underwent salvage cystectomy. We assessed using Kaplan-Meier method overall survival (OS), cancer specific survival (CSS), invasive recurrence-free survival (IRFS), metastasis-free survival (MFS), survival with bladder preserved (SBP), and toxicities. With a Cox model for OS and the Fine Gray method of competing risk for secondary endpoints, we analysed in univariate (u) and multivariate (m) analysis the impact of tumour characteristics and patient profiles: gender, age, age-adjusted Charlson comorbidity index, polypharmacy, and malnutrition. RESULTS From 1988 to 2017, 85 patients were included. After induction, complete response rate was 83.5%. With a median follow-up of 63 months, 5 year-OS, CSS, IRFS, MFS and SBP were 61.0%, 77.6%, 71%, 82.9%, and 70.2% respectively. A persistent tumour after induction impacted SBP (SHRm 3.61; p = 0.004), CSS (SHRm 3.27; p = 0.023), and MFS (SHRm 3.68; p = 0.018). Late grade 3 urinary and gastrointestinal toxicities were 3.5% and 1.2%. CONCLUSION We report here the largest series of bladder preservation over 75 years in a curative intent. Outcomes and tolerance in selected older adults compared favourably with surgical series and with CRT studies using classical fractionation.
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Affiliation(s)
- Aurélia Alati
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France.
| | - Emmanuelle Fabiano
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Romain Geiss
- Geriatric Department, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Alexis Mareau
- Clinical Research Unit, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Anais Charles-Nelson
- Clinical Research Unit, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Jean-Emmanuel Bibault
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Philippe Giraud
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Sarah Kreps
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Arnaud Méjean
- Department of Urology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Martin Housset
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Catherine Durdux
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
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Zapała Ł, Ślusarczyk A, Korczak B, Kurzyna P, Leki M, Lipiński P, Miłow J, Niemczyk M, Pocheć K, Późniak M, Przudzik M, Suchojad T, Wolański R, Zapała P, Drewa T, Roslan M, Różański W, Wróbel A, Radziszewski P. The View Outside of the Box: Reporting Outcomes Following Radical Cystectomy Using Pentafecta From a Multicenter Retrospective Analysis. Front Oncol 2022; 12:841852. [PMID: 35155267 PMCID: PMC8828538 DOI: 10.3389/fonc.2022.841852] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022] Open
Abstract
We aimed at characterization of the patients undergoing radical cystectomy (RC) using the prognostic model (a modified pentafecta). In the multicenter retrospective study, we enrolled 304 patients with bladder cancer (pTis-4N0-2M0) who underwent RC between 2015 and 2020 in experienced centers. The definition of the pentafecta was as follows: no Clavien–Dindo grade III–V complications at 90 days and no long-term complications related to urinary diversion <12 months, negative surgical margins, ≥10 lymph nodes (LNs) resected, and no recurrence ≤12 months. RC-pentafecta achievement rate was 22% (n = 67), varying from 47% to 88% attainment rate for different pentafecta components, and was the lowest for sufficient LN yield. Both 12-month recurrence-free survival (RFS) and cancer-specific mortality were compromised in pentafecta failers compared with achievers (57.8% vs. 100% and 33.8% vs. 1.5%, respectively). The following were identified as crucial predictors of RC pentafecta achievement: modality of the surgery, type of urinary diversion, histological type of bladder cancer, advanced staging, and elevated preoperative serum creatinine. In conclusion, we found that the pentafecta achievement rate was low even in high-volume centers in patients undergoing cystectomy. The complexity of the procedure directly influenced the attainment rate, which in turn led to an increase in cancer-specific mortality rate among the pentafecta failers.
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Affiliation(s)
- Łukasz Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Ślusarczyk
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Paweł Kurzyna
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Mikołaj Leki
- 2nd Clinic of Urology, Medical University of Lodz, Łódź, Poland
| | - Piotr Lipiński
- 2nd Clinic of Urology, Medical University of Lodz, Łódź, Poland
| | - Jerzy Miłow
- 2nd Clinic of Urology, Medical University of Lodz, Łódź, Poland
| | - Michał Niemczyk
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Kamil Pocheć
- Department of Urology, Regional Specialist Hospital, Kielce, Poland
| | - Michał Późniak
- Clinic of Urology, University Hospital No. 1, Bydgoszcz, Poland
| | - Maciej Przudzik
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Tomasz Suchojad
- Department of Urology, Regional Specialist Hospital, Kielce, Poland
| | - Rafał Wolański
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Zapała
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Drewa
- Clinic of Urology, University Hospital No. 1, Bydgoszcz, Poland
| | - Marek Roslan
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Andrzej Wróbel
- 2nd Clinic of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Radziszewski
- Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
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