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Radiation Treatment Timing and Dose Delivery: Effects on Bladder Cancer Cells in 3D in Vitro Culture. RADIATION 2022. [DOI: 10.3390/radiation2040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
While radical cystectomy remains the primary treatment of choice for bladder cancer, increased evidence supports the use of bladder-preservation strategies based on adjuvant radiotherapy. This highlights the need for a better understanding of bladder cancer radiosensitivity to different types of treatment deliveries. The purpose of this study is to analyze the effect of treatment time, dose and fractionation on the number and sizes of grown three-dimensional (3D) bladder cancer spheres, and to assess the capacity of the linear-quadratic model in describing the response of cells cultured in 3D. 3D MatrigelTM-based cultures were employed to enrich for cancer stem cells (CSCs) from three human bladder cancer cell lines, RT4, T24 and UM-UC-3. Three single dose radiation treatments were performed at different time points after plating, and sphere number and sizes were assessed. Anti-CD44 immunofluorescence, clonogenic assay and anti-γH2AX staining were also performed to analyze the cell lines’ radiosensitivity. The radiosensitivity of spheres was dependent on the treatment timing after plating. Current linear quadratic dose fractionation models were shown to over-estimate radiosensitivity in 3D models. Our results showed the importance of treatment timing on the radio-response of bladder cancer spheres. We also demonstrated that bladder cancer spheres are more resistant to dose-fractionation than the estimation from the theoretical linear-quadratic model.
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Surgical challenges and considerations in Tri-modal therapy for muscle invasive bladder cancer. Urol Oncol 2021; 40:442-450. [PMID: 33642229 DOI: 10.1016/j.urolonc.2021.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/13/2020] [Accepted: 01/08/2021] [Indexed: 01/20/2023]
Abstract
Trimodal therapy (TMT) for muscle invasive bladder cancer has become an accepted alternative to radical cystectomy and has become integrated into national guidelines as standard a treatment option. The urologist plays a critical role in proper patient selection, thorough transurethral resection, ongoing cystoscopic surveillance and management of local recurrences. There exists multiple patient related and tumor related factors, which contribute to the selection of TMT vs. radical cystectomy for a patient with muscle invasive bladder cancer. Although the ideal patient for TMT has a tumor which can undergo a visibly complete resection, has no associated hydronephrosis, does not invade the prostatic urethra and is not associated with diffuse carcinoma in situ throughout the bladder, select patients who do not meet all these criteria can still be successfully treated with this approach. A multidisciplinary approach including urology, radiation oncology and medical oncology is paramount with clear communication of tumor location, timing of chemoradiation and repeat cystoscopic resection followed by surveillance. Nonmuscle invasive bladder cancer recurrences can occur in up to 26% of patients after completion of TMT, with many being treated by routine and standard therapy for non-muscle invasive bladder cancer. However, in this population after TMT, early salvage cystectomy should be considered in those with adverse features, including T1 disease, tumor greater than 3 cm, CIS, or lymphovascular invasion. Salvage cystectomy can be performed for local recurrences with acceptable oncologic control and no clear evidence of any greater risk of early complications; however, there may be a slightly increased risk for late complications, namely small bowel obstruction, ureteral stricture, and parastomal hernia. An understanding of these surgical considerations is of utmost importance to the treating urologist in selecting and managing a patient through TMT.
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Bodgi L, Bahmad HF, Araji T, Al Choboq J, Bou-Gharios J, Cheaito K, Zeidan YH, Eid T, Geara F, Abou-Kheir W. Assessing Radiosensitivity of Bladder Cancer in vitro: A 2D vs. 3D Approach. Front Oncol 2019; 9:153. [PMID: 30941305 PMCID: PMC6433750 DOI: 10.3389/fonc.2019.00153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/22/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Bladder cancer is the fourth most commonly diagnosed cancer among males worldwide. Current treatment strategies established for bladder cancer mainly consist of cystectomy yet advances in radiation therapy have pointed to the value of organ-preserving strategies in preserving patients' quality of life. Aim: To study and compare the radiosensitivity in two-dimension (2D) and physiologically-relevant three-dimension (3D) in vitro culture of three human bladder cancer cell lines, RT4, T24, and UM-UC-3. Materials and Methods: Clonogenic assay was performed to assess cells' radiosensitivity in 2D. Employing the 3D Matrigel™-based cultures to enrich for cancer stem cells (CSCs) allowed us to assess the survival of this subpopulation of cells via evaluating the number, i.e., sphere forming unit (SFU), and the sizes of cultured spheres, formed from cells exposed to different radiation doses compared to non-irradiated cells. Results: Irradiating cells with increasing radiation doses revealed highest survival rates with RT4 cells in 2D, followed by T24 and UM-UC-3. In 3D, however, UM-UC-3 cells were shown to be the most radio-resistant as evidenced by the number of spheres formed, yet they displayed the least efficient volume reduction/regression (VR), whilst the volume decreased significantly for both RT4 and T24 cells. Sphere VR and sphere ratio (SR) values were then plotted against each other demonstrating a linear correlation between volume and number with RT4 and UM-UC-3 cell lines, but not T24. Lastly, multiple regression model was employed to evaluate the possibility of obtaining a function combining both 3D parameters, SR and VR, with the surviving fraction (SF) in 2D, and showed a linear regression for T24 cells only, with a correlation coefficient of 0.97 for the combined parameters. Conclusion: We were able to radiobiologically characterize 3 human bladder cancer cell lines showing differential effects of radiation between 2D and 3D culture systems, paving the way for achieving better assessment of radiosensitivity of bladder cancer in vitro.
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Affiliation(s)
- Larry Bodgi
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hisham F. Bahmad
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Tarek Araji
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Joelle Al Choboq
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jolie Bou-Gharios
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Katia Cheaito
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Youssef H. Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Toufic Eid
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fady Geara
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wassim Abou-Kheir
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Büchser D, Zapatero A, Rogado J, Talaya M, Martín de Vidales C, Arellano R, Bocardo G, Cruz Conde A, Pérez L, Murillo MT. Long-term Outcomes and Patterns of Failure Following Trimodality Treatment With Bladder Preservation for Invasive Bladder Cancer. Urology 2018; 124:183-190. [PMID: 30266376 DOI: 10.1016/j.urology.2018.07.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/15/2018] [Accepted: 07/25/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To report long-term results on survival, toxicity, and patterns of failure of 3 different organ-sparing strategies for patients with muscle invasive bladder cancer. MATERIALS AND METHODS This is a monoinstitutional prospective analysis of 3 consecutive bladder-sparing protocols combining maximal transurethral resection of bladder tumor (mTURBT), radiotherapy (RT), and cisplatin-based chemotherapy. Protocol 1 consisted of neoadjuvant methotrexate-cisplatin-vinblastine followed by endoscopic re-evaluation and consolidative RT 60 Gy in complete responders. Protocol 2 involved altered-fractionation RT 64.8 Gy and concurrent weekly cisplatin with re-evaluation after 40.8 Gy. Protocol 3 consisted of RT 64.8 Gy with concomitant weekly cisplatin. Nonresponders underwent radical cystectomy. Probabilities for overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were calculated using Kaplan-Meier product limited estimates. A Cox regression multivariate analysis was performed to detect potential risk factors for OS, CSS, and MFS. RESULTS The 10-year bladder preservation rate was 79%. The 10-year OS, CSS, and MFS rates were 43.2%, 76.3% and 79.2%, respectively. There was no statistically significant difference in OS between the different treatment protocols. On multivariate analysis, mTURBT of the bladder and the complete response after induction therapy were independent correlates of improved OS and of MFS. The development of invasive bladder recurrence was independently associated with worse CSS and MFS. CONCLUSION Ten-year results indicate that bladder-sparing treatment is a successful approach for muscle invasive bladder cancer in selected patients. The mTURBT of the bladder tumor and complete response after induction therapy remain the most relevant predictive factors.
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Affiliation(s)
- David Büchser
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Jacobo Rogado
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Marisol Talaya
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Ramón Arellano
- Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Gloria Bocardo
- Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Alfonso Cruz Conde
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Leopoldo Pérez
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
| | - María T Murillo
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain
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Olbert P, Goebell PJ, Hegele A. [Follow-up of bladder cancer : The right examinations at the right time]. Urologe A 2018; 57:693-701. [PMID: 29663062 DOI: 10.1007/s00120-018-0641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Schedules for the follow-up (FU) of bladder cancer patients are predominantly based on studies with low level of evidence and the resulting guidelines' recommendations that are often founded on expert consensus. FU of non-muscle invasive bladder cancer (NMIBC) includes cystoscopy and cytology as standard, and imaging modalities to a lower extent. FU of muscle-invasive bladder cancer (MIBC) depends primarily on the therapeutic modality chosen and on the stage of disease. In this scenario, FU is complemented by functional and quality of life related aspects. These apply even more for FU in palliative situations. Here, the individual focus is on examinations that might have a consequence in terms of survival and/or symptom relief.
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Affiliation(s)
- P Olbert
- Praxis und Belegabteilung für Urologie und Andrologie, Brixsana Private Clinic, Julius Durst Str. 28, 39042, Brixen, Italien.
| | - P J Goebell
- Urologische und Kinderurologische Klinik, Friedrich-Alexander Universität, Erlangen, Deutschland
| | - A Hegele
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Marburg UKGM, Marburg, Deutschland
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Giacalone NJ, Wu J, Chen MH, Renshaw A, Loffredo M, Kantoff PW, D'Amico AV. Prostate-Specific Antigen Failure and Risk of Death Within Comorbidity Subgroups Among Men With Unfavorable-Risk Prostate Cancer Treated in a Randomized Trial. J Clin Oncol 2017; 34:3781-3786. [PMID: 27601545 DOI: 10.1200/jco.2016.68.4530] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Physicians sometimes make management recommendations on the basis of early results from randomized controlled trials (RCTs) relating to reduced prostate-specific antigen (PSA) failure, yet whether this early end point is associated with all-cause mortality (ACM), particularly in men with competing risks, is unknown. Using a validated metric in men treated within the context of an RCT, we aimed to determine whether PSA failure is associated with the risk of ACM stratified by comorbidity score. Patients and Methods Between 1995 and 2001, 206 men with localized (T1b to 2b) intermediate- and high-risk prostate cancer (PC) were randomly assigned to receive radiation therapy or radiation therapy and 6 months of ADT. Cox regression analyses were performed to evaluate whether PSA failure modeled as a time-dependent covariate was associated with an increased risk of ACM among men with Adult Comorbidity Evaluation-27-defined no or minimal versus moderate-to-severe comorbidity adjusting for age, PC prognostic factors, and treatment. Results After a median follow-up of 16.62 years, 156 men (76%) died, 29 of whom (19%) died as a result of PC. PSA failure was associated with an increased ACM risk among men with no or minimal (adjusted hazard ratio, 1.59; 95% CI, 1.03 to 2.46; P = .04), but not moderate or severe comorbidity (adjusted hazard ratio, 1.75; 95% CI, 0.76 to 3.99; P = .19). Conclusion Recommending treatment on the basis of reduced PSA failure observed from early results of RCTs is unlikely to prolong survival in men with moderate-to-severe comorbidity but may prolong survival in men with no or minimal comorbidity, providing evidence to support discussing the early results with these men.
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Affiliation(s)
- Nicholas J Giacalone
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jing Wu
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ming-Hui Chen
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew Renshaw
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marian Loffredo
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Philip W Kantoff
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anthony V D'Amico
- Nicholas J. Giacalone, Marian Loffredo, and Anthony V. D'Amico, Brigham and Women's Hospital/Dana-Farber Cancer Institute; Nicholas J. Giacalone, Harvard Radiation Oncology Program, Boston, MA; Jing Wu and Ming-Hui Chen, University of Connecticut, Storrs, CT; Andrew Renshaw, Miami Baptist Hospital, Miami, FL; and Philip W. Kantoff, Memorial Sloan Kettering Cancer Center, New York, NY
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7
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Bonet M, Bonfill T, Nuñez M, Mur E, Arenas M. Trimodality therapy for older patients with bladder cancer: Overtreatment or benefit? J Geriatr Oncol 2017; 9:279-280. [PMID: 29233549 DOI: 10.1016/j.jgo.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 09/28/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Bonet
- Hospital Universitari Sant Joan de Reus, Department of Radiation Oncology, Tarragona, Spain; Consorci Sanitari de Terrassa, Department of Radiation Oncology, Terrassa, Spain.
| | - Teresa Bonfill
- Hospital Universitari Parc Taulí, Department of Medical Oncology, Sabadell, Spain
| | - Miriam Nuñez
- Consorci Sanitari de Terrassa, Department of Radiation Oncology, Terrassa, Spain
| | - Encarna Mur
- Consorci Sanitari de Terrassa, Department of Radiation Oncology, Terrassa, Spain
| | - Meritxell Arenas
- Hospital Universitari Sant Joan de Reus, Department of Radiation Oncology, Tarragona, Spain
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Bonet M, Bonfill T, Nuñez M, De Verdonces L, Mur E, Gallardo E, Fernandez-Morales L, Aguilar A, Prats J, Arenas M. Curative radiation therapy for very elderly bladder cancer patients with localized disease. Clin Transl Oncol 2017; 20:899-905. [DOI: 10.1007/s12094-017-1804-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
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9
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Arafat W, El Ashry MS, Abd Alrazek MAA, Matta CA, El Aleem EA, Kamel EM, Hussein M, Ezzat G, Samir M. The Relation between Survivin Gene Expression and Urinary Bladder Cancer Disease. HOSPICE AND PALLIATIVE MEDICINE INTERNATIONAL JOURNAL 2017; 1. [DOI: 10.15406/hpmij.2017.01.00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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10
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Wu CT, Lin WY, Chang YH, Chen WC, Chen MF. Impact of CD44 expression on radiation response for bladder cancer. J Cancer 2017; 8:1137-1144. [PMID: 28607587 PMCID: PMC5463427 DOI: 10.7150/jca.18297] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/24/2017] [Indexed: 12/13/2022] Open
Abstract
Background Identification of potential factors that can stratify tumors' response to specific therapies will aid in the selection of cancer therapy. Radioresistance is the major obstacles to positive outcomes in bladder cancer patients after definite chemotherapy. CD44, a cancer stem cell surface marker, is relevant in treatment resistance. In the present study, we examined the role of CD44 in bladder cancer. Methods We retrospectively analyzed the clinical outcomes of 85 bladder cancer patients treated with definite chemoradiotherapy, and correlated the expressions of CD44 with IL-6 and treatment response. Furthermore, the bladder cancer cell lines HT1197 and MB49 were selected for cellular and animal experiments to investigate the links between the CD44, IL-6 and radiation response. Results Analyzing the clinical specimen, the staining of CD44 was significantly linked with higher clinical stage, lower complete response rates, higher loco-regional failure rate and lower survival rate with intact bladder for patients treated with definite CCRT. In addition, the frequency of CD44 immunoreactivity was significantly higher in IL-6-positive bladder cancer specimens. By cellular experiments, the expression of CD44 was stimulated by IL-6 and linked with the cancer stem cell-like property. As demonstrated through in vitro and animal experiments using immunocompromised and immunocompetent hosts, CD44+ bladder cancer cells appeared more resistant to irradiation, associated with less RT-induced cell death. Conclusions Our findings suggested that CD44 is important in predicting the radiation response of bladder tumor cells. If overexpressed CD44 and/or IL-6 were noted in pre-surgical specimens, radical cystectomy is more likely to be preferred.
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Affiliation(s)
- Chun-Te Wu
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Yu Lin
- Chang Gung University, College of Medicine, Taoyuan, Taiwan.,Department of Urology, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, Chang Gung Memorial Hospital at Linko, Taiwan
| | - Wen-Cheng Chen
- Chang Gung University, College of Medicine, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Taiwan
| | - Miao-Fen Chen
- Chang Gung University, College of Medicine, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital at Chiayi, Taiwan
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Arafat W, Darwish A, Naoum GE, Sameh W, Husseiny GE, Abd-El-Gawad F, Samir M. Comparison between standard and reduced volume radiotherapy in bladder preservation trimodality protocol for muscle-invasive bladder cancer patients. Ecancermedicalscience 2016; 10:682. [PMID: 27899955 PMCID: PMC5102689 DOI: 10.3332/ecancer.2016.682] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Indexed: 01/23/2023] Open
Abstract
Aim Our aim is to compare the toxicity, pelvic nodal relapse, and overall survival of whole bladder irradiation only to the standard technique of whole pelvis irradiation followed by bladder boost in patients with muscle-invasive bladder carcinoma undergoing bladder preservation protocol. Material and method A total of 60 patients with transitional cell carcinoma, stage T2-3, N0, M0 bladder cancer were subjected to maximal transurethral resection bladder tumour (TURB). Then, the patients were randomised into two groups: group I (30 patients) to receive whole pelvis radiotherapy 44 Gy followed by 20 Gy bladder boost. While group II (30 patients) were randomised to receive whole bladder radiotherapy alone for a total dose of 64 Gy. In both groups, concomitant cisplatin and paclitaxel were given weekly throughout the whole course of radiotherapy where conventional 2 Gy/fraction were used. Additionally, four cycles of adjuvant cisplatin and paclitaxel were given after the end of the chemoradiotherapy induction course. Results The first assessment after the induction chemoradiotherapy showed that complete response was achieved in 73.3% of patients in group I and 76.7% of the patients in group II. After a median follow-up of 2 years, regional relapse occurred in 7.1% of patients in group I and 10.3% in group II. (p = 1). Distant metastases were detected in 17.9% of patient in group I and 13.8% in group II (p = 0.73). The 2-year disease-free survival was 60% in group I and 63.3% in group II (p = 0.79). The whole 2-year overall survival was 75% in group I and 79.3% in group II (p = 0.689). Radiation gastrointestinal (GI) acute toxicity was higher in group I than in group II (p = 0.001), while late GI radiation toxicity was comparable in both groups. Conclusion Treating the bladder only, without elective pelvic nodal irradiation, did not compromise pelvic control rate, but significantly decreased the acute radiation toxicity.
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Affiliation(s)
- Waleed Arafat
- Oncology Department, Faculty of Medicine, Alexandria University, Egypt; Alexandria Comprehensive Cancer Centre, Alexandria, Egypt; University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35233, USA
| | - Azza Darwish
- Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | - George E Naoum
- Alexandria Comprehensive Cancer Centre, Alexandria, Egypt
| | - Wael Sameh
- Urology Department, Faculty of Medicine, Alexandria University, Egypt
| | - Gamal El Husseiny
- Oncology Department, Faculty of Medicine, Alexandria University, Egypt
| | | | - Mostafa Samir
- Alexandria Comprehensive Cancer Centre, Alexandria, Egypt
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Abstract
BACKGROUND In many cases radical cystectomy is not feasible in patients suffering from muscle-invasive bladder cancer due to advanced age of the patient or limiting comorbidities which increase the perioperative risk. A further group of patients decline radical cystectomy due to potential postoperative complications and the resulting impairment in the quality of life. OBJECTIVES This article provides an overview of alternative therapeutic concepts to radical cystectomy in muscle-invasive bladder cancer. MATERIAL AND METHODS The study involved a database analysis and gives a discussion of clinical trials concerning alternative therapeutic concepts for muscle-invasive bladder cancer treatment strategies. RESULTS Transurethral resection, open partial cystectomy, radiotherapy, chemotherapy and combined therapeutic regimens are available as alternatives to radical cystectomy. CONCLUSION Radical cystectomy is the accepted standard of care in the treatment of muscle-invasive bladder cancer but in selected patients, established alternative methods can also be offered. A comprehensive patient information and counseling is therefore necessary to find the best therapeutic option in each individual case. Salvage cystectomy is a therapeutic option in cases of failure of organ-preserving treatment.
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Affiliation(s)
- C Niedworok
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland,
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13
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Zagouri F, Peroukidis S, Tzannis K, Kouloulias V, Bamias A. Current clinical practice guidelines on chemotherapy and radiotherapy for the treatment of non-metastatic muscle-invasive urothelial cancer: a systematic review and critical evaluation by the Hellenic Genito-Urinary Cancer Group (HGUCG). Crit Rev Oncol Hematol 2014; 93:36-49. [PMID: 25205597 DOI: 10.1016/j.critrevonc.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 12/15/2022] Open
Abstract
Radical cystectomy is the treatment of choice in localized muscle-invasive urothelial cancer. Nevertheless, relapses are frequent and systemic chemotherapy has been employed in order to reduce this risk. In addition, bladder preservation strategies are appealing. During the last decade, there has been a difficulty in conducting and completing large-scale trials in urothelial cancer. This has resulted in relatively few changes in the existing guidelines. Recent studies have created renewed interest in certain fields, such as the role of chemo-radiotherapy and management of unfit patients. In addition, application of certain guidelines has been limited in everyday practice. We conducted a systematic review of the existing guidelines and recent randomized trials not included in these guidelines, and developed a treatment algorithm, regarding non-surgical therapies for non-metastatic, muscle-invasive urothelial cancer based predominantly on patients' fitness for the available therapeutic modalities.
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Affiliation(s)
- F Zagouri
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - S Peroukidis
- Medical Oncology Department, University of Patras, Rion, Greece
| | - K Tzannis
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - V Kouloulias
- Radiotherapy Department, Attikon University Hospital, Athens, Greece
| | - A Bamias
- Department of Clinical Therapeutics, University of Athens, Athens, Greece.
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14
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Affiliation(s)
- Jong Chul Park
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - Deborah E. Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Piyush K. Agarwal
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Trimodality bladder-sparing approach versus radical cystectomy for invasive bladder cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2014. [DOI: 10.1017/s1460396914000107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposeTo compare the outcome among patients with invasive bladder cancer treated with cystectomy alone with outcome among those treated with combined-modality treatment in a randomised phase III trial.Patients and methodsPatients with histologically confirmed invasive non-metastatic bladder cancer T2-3, N0 and M0 were randomly assigned to two arms: Arm 1: of which all patients underwent radical cystectomy (RC) alone; and Arm 2, of which all patients were subjected to maximal transurethral resection of bladder tumour, followed 2 weeks later by combined chemoradiotherapy. The whole pelvis received 46 Gy in 23 fractions over 4·5 weeks. Chemotherapy was administered concomitantly with radiotherapy with: cisplatin 70 mg/m2 q. 3 weeks and Gemcitabine 300 mg/m2 D 1, 8 and 15 q. 3 weeks for two cycles. Patients who had complete response were shifted to phase II treatment: 20 Gy/10 fractions/2 weeks to the bladder. Patients with residual tumour underwent RC.ResultsOf the 80 patients assigned Arm 2, a visibly completed transurethral resection of the bladder tumour was possible in 48 patients (60%). Phase I of combined chemoradiotherapy (CCRT) was accomplished in 74 patients. Post-induction urologic evaluation revealed no evidence of disease in 62 patients (83·8%) and residual disease in 12 patients (16·2%). Phase II of CCRT was completed in 58 of the 62 patients. The median follow-up for all patients is 27 months (range: 4–49). The 3-year overall survival (OS) for the combined-modality group and for the surgery group were 61 and 63%, respectively (p = 0·425), whereas the disease-specific survival (DSS) for each group was 69 and 73%, respectively (p = 0·714). The 3-year OS with bladder preservation for Arm 2 patients was 50%.Multivariate analysis for the whole series showed that tumour stage and performance status (PS) were the only factors independently associated with DSS, although PS was the only factor independently associated with OS. In addition, residual disease after transurethral resection of the bladder tumour in Arm 2 patients was independently associated with both DSS and OS.Acute toxicity was moderate and most of the late toxicities were grade 2 with no grade 4 toxicity and no treatment-related deaths, none required cystectomy for bladder contraction.ConclusionThis study demonstrates that trimodality bladder-preserving approach represents a valid alternative for suitable patients. The OS and DSS rates of patients treated with trimodality bladder-preserving protocol are comparable to the results reported on patients treated with immediate radical cystectomy.
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Lendínez-Cano G, Rico-López J, Moreno S, Fernández Parra E, González-Almeida C, Camacho Martínez E. Elective bladder-sparing treatment for muscle invasive bladder cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.acuroe.2013.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Elective bladder-sparing treatment for muscle invasive bladder cancer. Actas Urol Esp 2014; 38:7-13. [PMID: 23790610 DOI: 10.1016/j.acuro.2013.03.004] [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: 01/09/2013] [Revised: 02/26/2013] [Accepted: 03/06/2013] [Indexed: 10/26/2022]
Abstract
OBJETIVES Radical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/- Chemotherapy+Radiotherapy to selected patients as an alternative. MATERIAL AND METHODS We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. RESULTS The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. CONCLUSIONS Although radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results.
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Sapre N, Anderson P, Foroudi F. Management of local recurrences in the irradiated bladder: a systematic review. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11476.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zapatero A, Martin De Vidales C, Arellano R, Ibañez Y, Bocardo G, Perez M, Rabadan M, García Vicente F, Cruz Conde JA, Olivier C. Long-term Results of Two Prospective Bladder-sparing Trimodality Approaches for Invasive Bladder Cancer: Neoadjuvant Chemotherapy and Concurrent Radio-chemotherapy. Urology 2012; 80:1056-62. [DOI: 10.1016/j.urology.2012.07.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 01/27/2023]
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Gorin MA, Ayyathurai R, Soloway MS. Diagnosis and treatment of bladder cancer: how can we improve? Postgrad Med 2012; 124:28-36. [PMID: 22691896 DOI: 10.3810/pgm.2012.05.2545] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The majority of patients with bladder cancer will be diagnosed following an episode of hematuria. With few exceptions, these patients should be referred for a complete urologic evaluation, including a history and physical examination, flexible cystoscopy, imaging of the upper urinary tract, and optional urine cytology. Those found to have a bladder tumor should undergo transurethral resection for the combined purposes of initial staging and treatment. Delays in diagnosing invasive bladder cancer are associated with adverse outcomes. In this review, we cover the diagnosis and management of bladder cancer. In addition, we discuss ways to improve outcomes through increased public awareness, improvements in tumor detection, accurate staging, and regimented patient surveillance.
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Affiliation(s)
- Michael A Gorin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Trimodality treatment in the conservative management of infiltrating bladder cancer: a critical review of the literature. Crit Rev Oncol Hematol 2012; 86:176-90. [PMID: 23088957 DOI: 10.1016/j.critrevonc.2012.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/21/2012] [Accepted: 09/26/2012] [Indexed: 11/23/2022] Open
Abstract
Although radical cystectomy is still the treatment of choice for patients with infiltrating bladder cancer, there is growing evidence of the effectiveness of a conservative approach. Developed as a treatment of need for elderly or unfit patients unable to undergo radical cystectomy, conservative therapy is becoming a true alternative to surgery for highly selected patients. Although transurethral bladder resection, external radiotherapy and systemic chemotherapy can control the disease as single treatments, the best results have been observed when they are combined. Moreover, new irradiation techniques and new-generation drugs are now being tested in an attempt to improve disease control further. Conservative management requires the multidisciplinary involvement of different specialties in order to give patients a real alternative to surgical treatment.
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Thoeny HC, Forstner R, De Keyzer F. Genitourinary Applications of Diffusion-weighted MR Imaging in the Pelvis. Radiology 2012; 263:326-42. [DOI: 10.1148/radiol.12110446] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Cucurbitacin E Induces G(2)/M Phase Arrest through STAT3/p53/p21 Signaling and Provokes Apoptosis via Fas/CD95 and Mitochondria-Dependent Pathways in Human Bladder Cancer T24 Cells. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:952762. [PMID: 22272214 PMCID: PMC3261502 DOI: 10.1155/2012/952762] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 09/25/2011] [Accepted: 10/02/2011] [Indexed: 11/28/2022]
Abstract
Cucurbitacin E, a tetracyclic triterpenes compound extracted from cucurbitaceous plants, has been shown to exhibit anticancer and anti-inflammatory activities. The purpose of this study was to elucidate whether cucurbitacin E promotes cell cycle arrest and induces apoptosis in T24 cells and further to explore the underlying molecular mechanisms. The effects of cucurbitacin E on T24 cell's growth and accompanied morphological changes were examined by MTT assay and a phase-contrast microscope. DNA content, mitochondrial membrane potential (ΔΨm) and annexin V/PI staining were determined by flow cytometry. The protein levels were measured by Western blotting. Our results demonstrated that cucurbitacin E-induced G2/M arrest was associated with a marked increase in the levels of p53, p21 and a decrease in phospho-signal transducer and activator of transcription 3 (STAT3), cyclin-dependent kinase 1 (CDK1) and cyclin B. Cucurbitacin E-triggered apoptosis was accompanied with up-regulation of Fas/CD95, truncated BID (t-BID) and a loss of ΔΨm, resulting in the releases of cytochrome c, apoptotic protease activating factor 1 (Apaf-1) and apoptosis-inducing factor (AIF), and sequential activation of caspase-8, caspase-9, and caspase-3. Our findings provided the first evidence that STAT3/p53/p21 signaling, Fas/CD95 and mitochondria-dependent pathways play critical roles in cucurbitacin E-induced G2/M phase arrest and apoptosis of T24 cells.
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Abstract
Management of muscle-invasive bladder cancer (MIBC) has changed little in the last twenty years. The gold standard treatment is still cystectomy, but it has a significant negative impact on quality of life. Bladder-preservation strategies can be used in some cases but patient selection for this approach remains unclear. New chemotherapy and biologic agents in combination with surgery or radiotherapy could improve results and these possibilities are currently under investigation.
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Current World Literature. Curr Opin Oncol 2011; 23:303-10. [DOI: 10.1097/cco.0b013e328346cbfa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wu CT, Wu CF, Lu CH, Lin CC, Chen WC, Lin PY, Chen MF. Expression and function role of DNA methyltransferase 1 in human bladder cancer. Cancer 2011; 117:5221-33. [DOI: 10.1002/cncr.26150] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/19/2011] [Accepted: 03/02/2011] [Indexed: 12/31/2022]
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