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Huang R, Chen M, Li H, An X, Xue C, Hu A, Shu D, Yang W, Zhou F, Sui D, Yao K, Li Y, Wu Z, Li Z, Liu Z, Shi Y. Effect of chemotherapy alone or combined with immunotherapy for locally advanced or metastatic genitourinary small cell carcinoma: a real-world retrospective study. BMC Cancer 2023; 23:1002. [PMID: 37858093 PMCID: PMC10585742 DOI: 10.1186/s12885-023-11473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Genitourinary small cell carcinoma is rare, and has a poor prognosis. However, effective treatment options for this disease are limited. We present a study to assess the efficacy of chemotherapy alone or combined with immunotherapy for locally advanced or metastatic genitourinary small cell carcinoma (GSCC). METHODS We performed a retrospective analysis of patients with locally advanced or metastatic GSCC from Jan 2013 to September 2022 at Sun Yat-sen University Cancer Center. The survival and safety profiles were analyzed. RESULTS Forty-two GSCC patients were enrolled, which included 20 with chemotherapy plus immunotherapy and 22 with chemotherapy alone. The median follow-up time was 15.13 months (95% CI, 8.84-21.42). The addition of immunotherapy to chemotherapy demonstrated no significant difference in median progression-free survival (p = 0.37). However, the median overall survival (OS) was 22.97 and 14.03 months with immunotherapy plus chemotherapy and chemotherapy alone, respectively (HR = 0.69, 95%CI 0.08-0.55, p = 0.017). Two patients with immunotherapy plus chemotherapy achieved clinical complete remission. The overall response rate for patients receiving chemotherapy combined with immunotherapy was 65%, which was higher in comparison to those treated with chemotherapy alone (50%). Univariate and multivariate analyses demonstrated that chemotherapy combined with immunotherapy independently achieved favorable OS. Four patients experienced immunotherapy-related adverse events, with one developing grade 3 hypothyroidism. CONCLUSIONS Among patients with locally advanced or metastatic GSCC, immunotherapy combined with chemotherapy might be thought of as a potentially effective treatment option for patients with GSCC.
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Affiliation(s)
- Riqing Huang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Meiting Chen
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Haifeng Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Xin An
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Cong Xue
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Anqi Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Ditian Shu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Wei Yang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China
| | - Fangjian Zhou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Urology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, People's Republic of China
| | - Dan Sui
- The Fourth People's Hospital of Shenyang, Shenyang, 110031, People's Republic of China
| | - Kai Yao
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Urology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, People's Republic of China
| | - Yonghong Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Urology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, People's Republic of China
| | - Zhiming Wu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Urology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, People's Republic of China
| | - Zhiyong Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Urology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, People's Republic of China
| | - Zhuowei Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- Department of Urology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, People's Republic of China.
| | - Yanxia Shi
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Dongfeng Road East 651, Guangzhou, 510060, China.
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Coppola A, Gatta T, Pini GM, Scordi G, Fontana F, Piacentino F, Minici R, Laganà D, Basile A, Dehò F, Carcano G, Franzi F, Uccella S, Sessa F, Venturini M. Neuroendocrine Carcinoma of the Urinary Bladder: CT Findings and Radiomics Signature. J Clin Med 2023; 12:6510. [PMID: 37892647 PMCID: PMC10607129 DOI: 10.3390/jcm12206510] [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: 09/30/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Background: We present a case series of Neuroendocrine Carcinoma of the Urinary Bladder (NECB) to analyse their radiologic appearance on CT, find a "Radiomic signature", and review the current literature. Methods: 14 CT cases of NECB were reviewed and compared with a control group of 42 patients with high-grade non-neuroendocrine bladder neoplasm for the following parameters: ring enhancement; implantation site; dimensions; density; margins; central necrosis; calcifications; number of lesions; wall thickness; depth of invasion in the soft tissue; invasion of fat tissue; invasion of adjacent organs; lymph-node involvement; abdominal organ metastasis. To extract radiomic features, volumes of interest of bladder lesions were manually delineated on the portal-venous phase. The radiomic features of the two groups were identified and compared. Results: Statistical differences among NECB and control group were found in the prevalence of male sex (100% vs. 69.0%), hydronephrosis (71.4% vs. 33.3%), mean density of the mass (51.01 ± 15.48 vs. 76.27 ± 22.26 HU); product of the maximum diameters on the axial plane (38.1 ± 59.3 vs. 14.44 ± 12.98 cm2) in the control group, trigonal region involvement (78.57% vs. 19.05%). About the radiomic features, Student's t-test showed significant correlation for the variables: "DependenceNonUniformity" (p: 0.048), "JointAverage" (p: 0.013), "LargeAreaLowGrayLevelEmphasis" (p: 0.014), "Maximum2DDiameterColumn" (p: 0.04), "Maximum 2DDiameterSlice" (p: 0.007), "MeanAbsoluteDeviation" (p: 0.021), "BoundingBoxA" (p: 0.022) and "CenterOfMassB" (p: 0.007). Conclusions: There is a typical pattern (male patient, large mass, trigonal area involvement) of NECB presentation on contrast-enhanced CT. Certain morphological characteristics and encouraging results about Radiomic features can help define the diagnosis.
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Affiliation(s)
- Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (T.G.); (F.F.); (F.P.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
| | - Tonia Gatta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (T.G.); (F.F.); (F.P.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
| | - Giacomo Maria Pini
- Department of Pathology, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Giorgia Scordi
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (T.G.); (F.F.); (F.P.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (T.G.); (F.F.); (F.P.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
| | - Roberto Minici
- Radiology Unit, Department of Experimental and Clinical Medicine, University Hospital Mater Domini, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (R.M.); (D.L.)
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, University Hospital Mater Domini, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy; (R.M.); (D.L.)
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital “Policlinico-Vittorio Emanuele”, 95123 Catania, Italy;
| | - Federico Dehò
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
- Urology Unit, CircoloHospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
- General, Emergency and Transplant Surgery Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Francesca Franzi
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
- Patology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Silvia Uccella
- Pathology Unit, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy;
| | - Fausto Sessa
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
- Patology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (T.G.); (F.F.); (F.P.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy; (F.D.); (G.C.); (F.F.); (F.S.)
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Mohanty P, Mohapatra AS, Sabat D, Nayak J. Unusual histomorphological spectrum of urinary bladder cancers and their treatment modalities revisited: Our experience with series of five cases. J Cancer Res Ther 2023; 19:617-623. [PMID: 37470584 DOI: 10.4103/jcrt.jcrt_134_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Urinary bladder cancer is the eighth-most frequent carcinoma in men, commonly occurs in elderly male. Major risk factors are smoking, chronic cystitis, urinary stones. The most common histologic variant of bladder cancer is urothelial carcinoma (UC), but certain variants are unusual yet aggressive for which there is no consensus guideline of therapy. Those entities include neuroendocrine tumors both primary and metastatic, squamous cell carcinoma, and sarcomatoid carcinoma. Neuroendocrine tumors comprise carcinoid, small-cell carcinoma, and large-cell carcinoma. Aim The present study is undertaken to highlight certain biological features of these unusual aggressive histological forms of bladder carcinoma and their recent treatment modality to prevent recurrence, metastasis, upgrading of tumor stage, and enable surprisingly complete remission. Methods This piece of hospital-based perspective study was done from June 2018 to May 2020. Both transurethral resection of bladder tumor and cystectomy surgical samples of the symptomatic patients were collected from the urology department of our institute along with demographic data. Then processed, stained in both routine H and E stain and immunohistochemical stains (Immunohistochemistry [IHC]) like PanCK, NSE, synaptophysin, chromogranin, etc. Results Total number of bladder cancer encountered was 42 cases; of these five rare variants were observed, i.e., one case each of primary and secondary small cell neuroendocrine carcinoma, one large cell carcinoma, one squamous cell carcinoma (SCC), and one case of sarcomatoid carcinoma. Histomorphology with IHC conferred the diagnosis then multimodality therapy (neoadjuvant/radiotherapy/surgery) was installed and followed up. Conclusion The unconventional forms of UC can be easily diagnosed by histomorphology and can have better survival with the help of the recent multimodal treatment approach.
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Affiliation(s)
- Pranita Mohanty
- Department of Pathology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Ajit S Mohapatra
- Department of Pathology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Debabrat Sabat
- Department of Urology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Jhasaketan Nayak
- Department of Hemato-oncology, AIIMS, Bhubaneswar, Odisha, India
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4
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Farooq M, Daniel S, Joel A, Thampi John N. Successful management of small cell neuroendocrine carcinoma of the ureter with neoadjuvant chemotherapy and adjuvant chemoradiation: case report and literature review. BMJ Case Rep 2021; 14:e240613. [PMID: 34404642 PMCID: PMC8375734 DOI: 10.1136/bcr-2020-240613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/04/2022] Open
Abstract
Neuroendocrine tumours (NETs) of the urinary tract are rare, and the urinary bladder is the the most common primary site. Primary ureteric NET is rarer with under 80 cases reported in the literature thus far. Most of these tumours are of the high-grade small cell neuroendocrine carcinoma subtype, which has a worse prognosis. Neoadjuvant chemotherapy has a proven role in the management of NET of the bladder as it downstages the tumour, which may add to significant recurrence-free survival and overall survival. We report the successful management of a patient with locally advanced small cell neuroendocrine carcinoma of the ureter, who had a pathological complete response after neoadjuvant chemotherapy with etoposide and cisplatin. He subsequently received adjuvant chemotherapy followed by radiation and is recurrence-free at a follow-up of 1 year.
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Affiliation(s)
- Mudasir Farooq
- Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
- Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sherin Daniel
- Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Medical oncology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nirmal Thampi John
- Urology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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5
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Chau C, Rimmer Frcr Y, Choudhury PhD A, Leaning Frcr D, Law A, Enting D, Lim Md JH, Hafeez PhD S, Khoo PhD V, Huddart PhD R, Mitchell Frcr D, Henderson Frcr DR, McGrane Frcr J, Beresford Frcr M, Vasudev PhD N, Beesley Frcr S, Hilman S, Manetta Frcr C, Sriram Frcs R, Sharma Md A, Eswar Frcr C, Treece Frcr S, Vilarino-Varela Frcr M, Varughese Frcr M, Glen PhD H, Pintus Md E, Crabb PhD S. Treatment Outcomes for Small Cell Carcinoma of the Bladder: Results From a UK Patient Retrospective Cohort Study. Int J Radiat Oncol Biol Phys 2021; 110:1143-1150. [PMID: 33561506 DOI: 10.1016/j.ijrobp.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Small cell carcinoma of the bladder (SCCB) is rare, accounting for less than 1% of all bladder carcinomas. It is aggressive, and outcomes are poor as a result of its early metastatic spread. Owing to its rarity, there are limitations on data to propose standardized management pathways. METHODS AND MATERIALS We conducted a retrospective analysis of patients presenting with pure or predominant-histology SCCB to 26 institutions in the United Kingdom between 2006 and 2016. The data cutoff date was February 1, 2018. We report patient characteristics, treatment received, and subsequent clinical outcomes. RESULTS A total of 409 eligible patients were included. Among these, 306 (74.8%) were male, the median age was 71 years (range, 35-96 years), and 189 patients (46.2%) had pure-histology SCCB. At data cutoff, 301 patients (73.6%) had died. The median overall survival (OS) was 15.9 months (95% CI, 13.2-18.7 months). Two hundred patients (48.9%) were confirmed to have bladder-confined disease (N0, M0), with a median OS of 28.3 months (95% CI, 20.9-35.8 months), versus a median OS of 12.7 months (95% CI, 10.9-14.6 months) for the 172 patients (42.1%) with confirmed N1-3 and/or M1 disease (hazard ratio [HR], 2.03; 95% CI, 1.58-2.60; P < .001). A total of 247 patients (61.5%) received primary chemotherapy, with a median OS of 21.6 months (95% CI, 15.5-27.6 months), versus a median OS of 9.1 months (95% CI, 5.4-12.8 months) in patients who did not receive primary chemotherapy (HR, 0.46; 95% CI, 0.37-0.59; P < .001). Choice of chemotherapy agent did not alter outcomes. For those with bladder-confined disease, 61 (30.5%) underwent cystectomy, and 104 (52.0%) received radiation therapy. Survival outcomes were similar for both cystectomy and radiation therapy. Only 6 patients (1.5%) were identified as having brain metastases at any time point. CONCLUSIONS To our knowledge, this is the largest retrospective study of all-stage SCCB to date. Patients have a poor prognosis overall, but survival is improved in those able to receive chemotherapy and with organ-confined disease. Brain metastases are rare.
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Affiliation(s)
- Caroline Chau
- Oncology, Queen Alexandra Hospital Portsmouth Oncology Centre, Portsmouth, United Kingdom; Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Yvonne Rimmer Frcr
- Clinical Oncology, Cambridge University Hospital NHS Trust, Cambridge, United Kingdom
| | | | - Darren Leaning Frcr
- Oncology, South Tees Hospital NHS Foundation Trust, South Tees, United Kingdom
| | - Alastair Law
- Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland
| | - Deborah Enting
- Oncology, Guys St Thomas Hospital Trust, London, United Kingdom
| | - Jun Hao Lim Md
- Oncology, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Shaista Hafeez PhD
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Vincent Khoo PhD
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Robert Huddart PhD
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | | | - John McGrane Frcr
- Oncology, Sunrise Oncology Centre, Royal Cornwall Hospital Trust, Cornwall, United Kingdom
| | | | | | | | - Serena Hilman
- Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom
| | | | | | - Anand Sharma Md
- Oncology, East and North Herts NHS Trust, Northwood, United Kingdom
| | | | - Sarah Treece Frcr
- Oncology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, United Kingdom
| | | | | | | | | | - Simon Crabb PhD
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
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Stelwagen J, de Vries EGE, Walenkamp AME. Current Treatment Strategies and Future Directions for Extrapulmonary Neuroendocrine Carcinomas: A Review. JAMA Oncol 2021; 7:759-770. [PMID: 33630040 DOI: 10.1001/jamaoncol.2020.8072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Patients with extrapulmonary neuroendocrine carcinomas (EPNECs) receive essentially the same treatment as those with small cell lung cancer (SCLC) despite differences in origin, clinical course, and survival. This SCLC-based approach is attributable to the rarity of EPNECs, which impedes the use of randomized clinical trials. However, neuroendocrine carcinomas are becoming more common because of the increasing use of systemic cancer therapy for adenocarcinomas. This treatment can transdifferentiate certain adenocarcinomas into neuroendocrine carcinomas. In addition, the treatment landscape for SCLC is slowly changing, potentially impacting the treatment paradigms for EPNECs. Observations New information on tumorigenesis of EPNECs from different origins, either as a primary malignant tumor or after neuroendocrine differentiation from adenocarcinomas, demonstrates their biological similarity. Activated molecular pathways that appear to underlie the development of EPNECs are potentially targetable, and some of these targets, such as poly(adenosine diphosphate-ribose) polymerase, Wee1, and Aurora A kinase, are currently under investigation. Immune checkpoint inhibitors (ICIs) already constituted a new treatment modality for patients with SCLC and produced some promising results in patients with EPNECs. Conclusions and Relevance Although only moderately effective, the introduction of ICIs signifies the first new option in systemic treatment of SCLC in decades. To prove the value of ICIs and other new drugs for patients with EPNECs, these patients should be included in clinical trials independent of the primary tumor site. Furthermore, to optimize clinical decision-making for patients with EPNECs, experts from the neuroendocrine tumor board should collaborate with members from tumor site-specific boards, which will require patient referral to a center with EPNEC expertise.
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Affiliation(s)
- Johannes Stelwagen
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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7
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Ma J, Black PC. Current Perioperative Therapy for Muscle Invasive Bladder Cancer. Hematol Oncol Clin North Am 2021; 35:495-511. [PMID: 33958147 DOI: 10.1016/j.hoc.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radical cystectomy is curative in only approximately 50% of patients with muscle-invasive bladder cancer. Although perioperative radiotherapy has been tested with the intent of improving locoregional disease control, there currently is no role for this modality in routine care. Perioperative systemic therapy is used with the intent of reducing the risk of systemic recurrence. Robust trial evidence supports the use of neoadjuvant cisplatin-based chemotherapy, with adjuvant chemotherapy offered as an alternative if neoadjuvant therapy is not administered. Perioperative immunotherapy represents the next frontier in perioperative therapy. Further biomarker development is required to guide treatment in individual patients.
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Affiliation(s)
- Joshua Ma
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada.
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8
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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9
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Liu Y, Xu H, Wu B, Liu S, Luo Q. Small cell carcinoma of the bladder with coexisting prostate adenocarcinoma: two cases report and literature review. BMC Urol 2020; 20:134. [PMID: 32859184 PMCID: PMC7456054 DOI: 10.1186/s12894-020-00705-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary small cell carcinoma of the bladder (SCCB) is a rare disease of the genitourinary tract and reported limitedly. SCCB is very aggressive and always mixed with other histologic components, but coexistence of SCCB and prostate adenocarcinoma is extremely rare. CASES PRESENTATION Two aged males (72 and 58 years) were included in this study. Both of them presented with gross hematuria as initial symptom. Magnetic resonance imaging (MRI) demonstrated protruding lesions in the urinary bladder. Pathological examination after radical cystectomy and prostatectomy showed the concurrence of SCCB and prostate adenocarcinoma. One patient died of liver and lung metastasis 8 months after surgery, and the other patient was still alive after 19 months of follow-up. CONCLUSION In this paper, we reported two unusual cases of coexistence of SCCB and prostate adenocarcinoma, and reviewed relative literatures with respect to the epidemiology, clinical features, pathologic features, diagnosis, treatment and prognosis of SCCB.
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Affiliation(s)
- Yanxia Liu
- Department of Pathology, Jiangyin People's Hospital, Affiliated Jiangyin Hospital of the Southeast University Medical College, Jiangyin, 214400, Jiangsu Province, China
| | - Hongming Xu
- Department of Pathology, Jiangyin People's Hospital, Affiliated Jiangyin Hospital of the Southeast University Medical College, Jiangyin, 214400, Jiangsu Province, China
| | - Bin Wu
- Department of Urology, Jiangyin People's Hospital, Affiliated Jiangyin Hospital of the Southeast University Medical College, Jiangyin, 214400, Jiangsu Province, China
| | - Shuguang Liu
- Department of Urology, Tianjin Jinnan Hospital, Tianjin, 300350, China
| | - Qiang Luo
- Department of Urology, Jiangyin People's Hospital, Affiliated Jiangyin Hospital of the Southeast University Medical College, Jiangyin, 214400, Jiangsu Province, China.
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10
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Qayoom S, Chakrabarti D, Khan F, Goel MM. Primary small cell carcinoma of the urinary bladder. BMJ Case Rep 2019; 12:12/9/e230185. [PMID: 31570346 DOI: 10.1136/bcr-2019-230185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Small cell carcinoma of the urinary bladder (SCCB) is an extremely rare but aggressive tumour constituting less than 0.7% of all urinary bladder tumours. It is often misdiagnosed as transitional cell carcinoma, owing to the similarities in presentation. Diagnosis of SCCB is based on the WHO criteria for small cell lung carcinoma. A 58-year-old man who had presented with haematuria and burning micturition for 3 months was initially diagnosed as high-grade muscle-invasive urothelial carcinoma based on the TURBT specimen. The patient was put on neoadjuvant chemotherapy, but presented again with haematuria and back pain after 3 months. Imaging studies showed a lesion in the posterolateral wall of the urinary bladder, along with partial collapse and anterior wedging of L1 vertebra. He underwent TURBT, and on the basis of histopathology and immunohistochemistry, a diagnosis of primary SCCB bladder with vertebral metastasis was made.
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Affiliation(s)
- Sumaira Qayoom
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Deep Chakrabarti
- Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Fatima Khan
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Madhu Mati Goel
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
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11
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Burity CRT, Ferreira FT, Veiga AF, Saade RD. Advanced small-cell bladder cancer into a ureterocele: A case report and literature review. Urol Case Rep 2019; 27:100986. [PMID: 31440452 PMCID: PMC6700426 DOI: 10.1016/j.eucr.2019.100986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
Small cell bladder cancer (SCBC) is found in 0.5–1.2% of all bladder tumors. Ureteroceles are dilatation of the distal portion of an ectopic ureter, which association with tumors are rare. This article reports the first case described of an SCBC developed into a ureterocele, beyond a literature review.
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Affiliation(s)
- Camila R T Burity
- Hospital Municipal Dr. Mário Gatti, Av. Pref. Faria Lima, 340, Campinas, SP, 13036-902, Brazil
| | - Fábio T Ferreira
- Hospital Municipal Dr. Mário Gatti, Av. Pref. Faria Lima, 340, Campinas, SP, 13036-902, Brazil
| | - André F Veiga
- Hospital Municipal Dr. Mário Gatti, Av. Pref. Faria Lima, 340, Campinas, SP, 13036-902, Brazil
| | - Ricardo D Saade
- Hospital Municipal Dr. Mário Gatti, Av. Pref. Faria Lima, 340, Campinas, SP, 13036-902, Brazil
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12
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Prognostic Variables in Patients With Non-metastatic Small-cell Neuroendocrine Carcinoma of the Bladder: A Population-Based Study. Clin Genitourin Cancer 2019; 17:e724-e732. [DOI: 10.1016/j.clgc.2019.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/05/2019] [Accepted: 03/17/2019] [Indexed: 12/17/2022]
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13
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Williams HA, Punjani N, Khan O, Power NE. The oncological outcomes of small cell carcinoma of the bladder. Can Urol Assoc J 2018; 13:260-265. [PMID: 30526804 DOI: 10.5489/cuaj.5579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Small cell carcinoma of the bladder (SmCC) is a rare and aggressive genitourinary malignancy. The paucity of clinical trials and outcome data provide no standard treatment guidelines. Accordingly, patient prognosis is poor. Our goal was to present the first comprehensive in-depth analysis of SmCC in a tertiary Canadian centre. METHODS We retrospectively reviewed all patients diagnosed with primary SmCC at the London Regional Cancer Program between January 1990 and 2016. The primary outcome was overall survival (OS). We examined a number of secondary outcomes and baseline characteristics. RESULTS We identified 15 men and six women (median age 72 years) with a SmCC diagnosis (median followup 11.33 months). Median Charlson Comorbidity Index score was 7 (interquartile range [IQR] 5-10) and 15 patients had a smoking history. Most common presentation was gross hematuria (18 patients, 86%), and pT2 stage at transurethral resection of the bladder tumour (TURBT) (n= 7/21, 33%), although five patients had cT4 (24%). Pure SmCC was found in nine individuals (43%), whereas 12 had mixed differentiation (57%). From initial staging, 15 patients had extravesical disease (71%), 10 had positive pelvic lymphadenopathy (48%), and distant metastases occurred in six (29%). In our series, five individuals (24%) underwent cystectomy, 18 (86%) received radiation, and 14 (67%) received adjuvant chemotherapy. The median OS was 15 months (two-year OS was 19%). CONCLUSIONS SmCC is a rare and aggressive form of bladder cancer. Despite multimodal therapy, prognosis remains guarded, with little improvement seen over the study's 25-year duration. An understanding of study limitations is warranted in interpretation of results.
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Affiliation(s)
- Harley A Williams
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nahid Punjani
- Department of Surgery, Division of Urology, University of Western Ontario, London, ON, Canada
| | - Obaidullah Khan
- Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nicholas E Power
- Department of Surgery, Division of Urology, University of Western Ontario, London, ON, Canada
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14
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Li Z, Lin C, Wang D, Xie J, Zhou C, Chen P, Yang Y, Sun S, Peng J, Yang S, Lai Y. Primary small-cell neuroendocrine carcinoma of the urinary bladder: A rare case and a review of the literature. Mol Clin Oncol 2018; 9:335-338. [PMID: 30155256 PMCID: PMC6109670 DOI: 10.3892/mco.2018.1679] [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: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 02/05/2023] Open
Abstract
Primary small-cell neuroendocrine carcinoma (SCNEC) of the urinary bladder is a rare tumor characterized by poor differentiation and high aggressiveness. Only ~150 cases have been reported in the literature to date. We herein present a case of an 87-year-old man who presented with hematuria and was found to have an ill-defined mass in the urinary bladder on computed tomography and cystoscopic examination. On pathological examination following tumor biopsy, the mucosa of the bladder wall was found to be extensively infiltrated by neuroendocrine carcinoma, positive for CD56 and synaptophysin and negative for epithelial membrane antigen, consistent with SCNEC of the urinary bladder. The patient refused further surgical treatment and succumbed to the disease 2 months after the diagnosis. In the present study, this rare case of primary SCNEC of the urinary bladder is presented, along with a discussion on the clinical presentation, immunohistochemical and cytomorphological characteristics, management, biological behavior and prognosis of this disease.
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Affiliation(s)
- Zuwei Li
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Canbin Lin
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Danyun Wang
- Department of Anesthesiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Jiansen Xie
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Cankun Zhou
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Peijie Chen
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Department of Urology, Shantou University Medical College, Shantou, Guangdong 515041, P.R. China
| | - Yu Yang
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Shuolei Sun
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Jian Peng
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Shangqi Yang
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
| | - Yongqing Lai
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong 518036, P.R. China
- Correspondence to: Professor Yongqing Lai, Department of Urology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen, Guangdong 518036, P.R. China, E-mail:
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15
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Safini F, Jouhadi H, Marnissi F, Bouchbika Z, Benchakroun N, Tawfiq N, Sahraoui S, Benider A. [Small cell neuroendocrine carcinoma of the bladder: Report of five cases and a review of the literature]. Cancer Radiother 2018; 22:417-422. [PMID: 30049597 DOI: 10.1016/j.canrad.2017.11.014] [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: 09/15/2017] [Revised: 11/17/2017] [Accepted: 11/30/2017] [Indexed: 10/28/2022]
Abstract
Neuroendocrine small cell carcinoma of the bladder is a rare and aggressive tumour, accounting for less than 1% of all bladder tumours. Given its rarity and the absence of randomized trials, the therapeutic management of these tumours remains difficult. By analogy with small cell lung cancer, multimodal treatment is often proposed. Radical cystectomy plus chemotherapy and chemoradiation therapy are associated with better survival compared to monotherapy. We report our experience in the management of these tumours with literature review.
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Affiliation(s)
- F Safini
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc.
| | - H Jouhadi
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc
| | - F Marnissi
- Laboratoire d'anatomopathologie, CHU Ibn-Rochd, 20503 Casablanca, Maroc
| | - Z Bouchbika
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc
| | - N Benchakroun
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc
| | - N Tawfiq
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc
| | - S Sahraoui
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc
| | - A Benider
- Centre Mohammed-VI pour le traitement des cancers, CHU Ibn-Rochd, quartier des hôpitaux, 20360 Casablanca, Maroc
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16
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Ram D, Rajappa SK, Babu Koyyala VP, Chatterjee S, Bhakuni YS, Shukla Singh HA, Singh A, Rawal S. Small Cell Carcinoma of Urinary Bladder: Analysis from a Tertiary Cancer Care Center of India. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_30_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Context: Small cell cancer of the urinary bladder. Aims: Small cell carcinoma of the bladder is a rare histological subtype, which is particularly aggressive and global literature available describing this entity is sparse. This review of our database was to evaluate clinicopathological and survival outcomes of these patients. Subjects and Methods: The present study was a retrospective analysis of patients with small cell bladder cancer for past 6 years at Rajiv Gandhi Cancer Institute and Research Center, New Delhi. Results:: Most of the patients in our study presented with limited stage disease. The overall survival and disease-free survival (DFS) was 49% and 51.07% at 2 years, respectively. Preoperative chemotherapy with surgical resection has shown significant survival and DFS benefit. Stage at presentation also affected the survival and DFS though it did not reach statistical significance. Conclusions: Small cell bladder cancer is a rare disease with dismal prognosis. Multimodality treatment with neoadjuvant chemotherapy should be the preferred treatment for limited stage disease.
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Affiliation(s)
- Dharma Ram
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Suhas Kodasoge Rajappa
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - Smaranjeet Chatterjee
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Yogendra Singh Bhakuni
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | | | - Amitabh Singh
- Department of Uro-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sudhir Rawal
- Department of Uro-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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17
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van de Kamp M, Meijer R, Pos F, Kerst M, van Werkhoven E, van Rhijn B, Horenblas S, Bex A. Intravesical recurrence after bladder sparing treatment of small cell carcinoma of the bladder: Characteristics, treatment, and outcome. Urol Oncol 2018; 36:307.e1-307.e8. [DOI: 10.1016/j.urolonc.2018.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022]
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18
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Pasquier D. In Reply to El Majjaoui et al. Int J Radiat Oncol Biol Phys 2018; 101:237-238. [DOI: 10.1016/j.ijrobp.2018.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 11/29/2022]
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19
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Bokarica P. Orthotopic neobladder in patient with locally advanced small cell carcinoma of the bladder: a case report and review of the literature. J Surg Case Rep 2017; 2017:rjx005. [PMID: 28458816 PMCID: PMC5400478 DOI: 10.1093/jscr/rjx005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/28/2016] [Accepted: 01/13/2017] [Indexed: 11/13/2022] Open
Abstract
Small cell carcinoma of the urinary bladder (SCCUB) is a rare, aggressive variant of neuroendocrine nonepithelial tumor. The best treatment results are achieved by combined cystectomy and chemotherapy. Same as in urothelial bladder cancer, a question remains about the urinary diversion in locally advanced disease. Studies on surgical treatment of patients with SCCUB most often do not clearly specify the type of urinary diversion performed, and we could not find information that orthotopic urinary diversion was performed in those patients. We present a 58-year-old patient with locally advanced SCCUB, treated by cystectomy and orthotopic urinary diversion (ileal neobladder-Hautmann) followed by six-cycle adjuvant chemotherapy. After 50-month follow-up, the patient showed no signs of relapse and the new bladder functioned perfectly well.
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Affiliation(s)
- Pero Bokarica
- Department of Urology, Clinical Hospital Sveti Duh, Zagreb, Croatia
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20
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Ghervan L, Zaharie A, Ene B, Elec FI. Small-cell carcinoma of the urinary bladder: where do we stand? ACTA ACUST UNITED AC 2017; 90:13-17. [PMID: 28246491 PMCID: PMC5305081 DOI: 10.15386/cjmed-673] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 04/11/2016] [Indexed: 12/17/2022]
Abstract
Small-cell carcinoma of the urinary bladder is a very rare pathology, but with a very aggressive behavior and disappointing prognosis. The literature concerning this type of cancer is scarce and physicians may encounter difficulty trying to manage it. Most articles involve the study of case series, without definite results due to the small number of patients. The present article aims at gathering the most significant articles and results in order to offer a broad perspective on the existing literature concerning this pathology.
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Affiliation(s)
- Liviu Ghervan
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Andreea Zaharie
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Bogdan Ene
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
| | - Florin I Elec
- Clinical Institute of Urology and Renal Transplantation, Cluj-Napoca, Romania
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21
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Rare Occurrence of a Poorly Differentiated Neuroendocrine Tumor of the Bladder. Case Rep Med 2017; 2017:4812453. [PMID: 28115940 PMCID: PMC5237721 DOI: 10.1155/2017/4812453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 01/27/2023] Open
Abstract
Neuroendocrine tumors rarely occur in the urinary bladder. They can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Review of the recent literature shows equivalent survival data for localized disease treated with chemoradiotherapy combined with either bladder sparing surgery or radical cystectomy. Patients with significant comorbidities are an additional challenge. We report a case of poorly differentiated neuroendocrine tumor of the bladder, which could not be classified as small or large cell carcinoma, complicated by significant comorbidities. After management with transurethral resection of the tumor, adjuvant chemotherapy, and radiation, the patient is alive and asymptomatic nearly 1 year after initial TURBT with no evidence of disease recurrence.
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22
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Heidegger I, Tulchiner G, Schäfer G, Horninger W, Pichler R. Long term disease free survival with multimodal therapy in small cell bladder cancer. Eur J Med Res 2016; 21:40. [PMID: 27737712 PMCID: PMC5064780 DOI: 10.1186/s40001-016-0234-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022] Open
Abstract
Background Small cell bladder cancer (SCBC) is an aggressive subtype accounting for less than 1 % of all bladder malignancies associated with rapid progression, early metastases formation and high mortality rates. Case presentation We present an unusual long term disease free survival of a 60 year-old man who was diagnosed with SCBC two and a half years ago. He underwent four cycles of cisplatin/etoposide chemotherapy as well as a prophylactic whole-brain radiotherapy followed by a radical cystoprostatectomy and ileal neobladder with extended pelvic lymphadenectomy. Since 33 months the patient is now recurrence-free. Conclusion In this case report, we were able to show that early multimodal therapy results in long term disease free survival, thus we highly recommend neoadjuvant chemotherapy as a part of multimodal management of a primary metastases-free, localized and surgically resectable SCBC.
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Affiliation(s)
- Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Gennadi Tulchiner
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Georg Schäfer
- Division of General Pathology, Department of Pathology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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23
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Jung K, Ghatalia P, Litwin S, Horwitz EM, Uzzo RG, Greenberg RE, Viterbo R, Geynisman DM, Kutikov A, Plimack ER, Smaldone MC, Wong YN, Bilusic M. Small-Cell Carcinoma of the Bladder: 20-Year Single-Institution Retrospective Review. Clin Genitourin Cancer 2016; 15:e337-e343. [PMID: 27991416 DOI: 10.1016/j.clgc.2016.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Small-cell carcinoma of the bladder is a poorly differentiated neoplasm with aggressive behavior. We analyzed clinical outcomes of patients who were treated at our institution to identify an optimal treatment strategy. MATERIALS AND METHODS Retrospective chart analysis was performed for patients who were treated for small-cell carcinoma of the bladder at Fox Chase Cancer Center between 1995 and 2015. Survival was compared between different treatment periods (before January 2010 vs. after January 2010) and different treatment modalities (surgery vs. neoadjuvant chemotherapy vs. radiation). RESULTS Thirty-eight patients were treated for small-cell carcinoma of the bladder at our institution during the 20-year study period. Median survival was 11.8 months and overall survival rates after 1, 3, and 5 years were 46.6%, 26.2%, and 14%, respectively. Survival analysis adjusted for age, histology, and stage showed that no single treatment strategy was significantly superior (95% confidence interval [CI], 0.26-3.03; P = .860 for surgery; 95% CI, 0.31-2.87; P = .928 for neoadjuvant chemotherapy; 95% CI, 0.65-5.49; P = .238 for radiation). In separate analyses of long-term survivors, we found that most received platinum-based neoadjuvant chemotherapy followed by radical cystectomy. Among the 20 patients who received neoadjuvant chemotherapy, downstaging occurred in 9 (45%). CONCLUSION Although none of the treatment options were found to be significantly superior with respect to survival, neoadjuvant chemotherapy might halt the progression of the disease until cystectomy and lead to downstaging. At our institution, the best outcomes were observed in patients who received neoadjuvant platinum-based chemotherapy combined with radical cystectomy.
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Affiliation(s)
- Kyungsuk Jung
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA.
| | - Pooja Ghatalia
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Samuel Litwin
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Rosalia Viterbo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Daniel M Geynisman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Yu-Ning Wong
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Marijo Bilusic
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Erdem GU, Özdemir NY, Demirci NS, Şahin S, Bozkaya Y, Zengin N. Small cell carcinoma of the urinary bladder: changing trends in the current literature. Curr Med Res Opin 2016; 32:1013-21. [PMID: 26889739 DOI: 10.1185/03007995.2016.1155982] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Extrapulmonary small cell carcinoma (SmCC), also known as oat cell carcinoma or small cell neuroendocrine carcinoma, is characterized by an aggressive clinical course with early metastasis pattern and a short life expectancy. So far, there is no prospective, data-based case-control study due to its low incidence. The purpose of this paper is to discuss the epidemiology, morphopathology, clinical characteristics, differential diagnosis and treatment of bladder SmCC in the light of the literature. Scope PubMed and American Society of Clinical Oncology Meeting abstracts were searched according to the following keywords: 'extrapulmonary SmCC', 'bladder cancer', and 'therapeutic approach'. The last search was performed on 1 October 2015. Some additional papers were determined by reviewing references of the appropriate articles. Most of the data regarding small cell carcinoma of the urinary bladder (SmCCB) were found to be based on the retrospective trials. Findings Bladder SmCC is more frequent in men and usually appears in the seventh to eighth decades. Macroscopic hematuria is the most common clinical symptom. The diagnosis of SmCCB is performed based on the same criteria determined by the WHO classification for the diagnosis of small cell lung carcinoma (SCLC). Prognosis is closely correlated with the stage at presentation. Although the prognosis of the disease is poor, a long survival can be achieved particularly by radical surgery following neoadjuvant chemotherapy in patients with early stage tumors. Cystectomy is still the current standard local treatment. However, cystectomy alone is not sufficient. Chemotherapy and definitive radiotherapy should be preferred for limited disease in patients who are not candidate for surgery. Conclusion Considering the poor prognosis of the disease, further studies are needed to determine the optimal treatment options and new molecular markers in the way of early diagnosis and favorable outcomes. Prospective, multicenter, randomized studies are required to evaluate the role of neoadjuvant chemotherapy followed either by surgery or radiotherapy.
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Affiliation(s)
- Gökmen Umut Erdem
- a Ankara Numune Education and Research Hospital , Department of Medical Oncology , Ankara , Turkey
| | - Nuriye Yıldırım Özdemir
- a Ankara Numune Education and Research Hospital , Department of Medical Oncology , Ankara , Turkey
| | - Nebi Serkan Demirci
- a Ankara Numune Education and Research Hospital , Department of Medical Oncology , Ankara , Turkey
| | - Süleyman Şahin
- b Dışkapı Education and Research Hospital , Department of Medical Oncology , Ankara , Turkey
| | - Yakup Bozkaya
- a Ankara Numune Education and Research Hospital , Department of Medical Oncology , Ankara , Turkey
| | - Nurullah Zengin
- a Ankara Numune Education and Research Hospital , Department of Medical Oncology , Ankara , Turkey
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Prognostic significance of serum neuron-specific enolase in small cell carcinoma of the urinary bladder. World J Urol 2016; 35:97-103. [DOI: 10.1007/s00345-016-1846-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022] Open
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Prelaj A, Rebuzzi SE, Magliocca FM, Speranza I, Corongiu E, Borgoni G, Perugia G, Liberti M, Bianco V. Neoadjuvant Chemotherapy in Neuroendocrine Bladder Cancer: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:248-53. [PMID: 27072610 PMCID: PMC4831333 DOI: 10.12659/ajcr.896989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Small cell carcinoma of the urinary bladder is a rare and aggressive form of bladder cancer that mainly presents at an advanced stage. As a result of its rarity, it has been described in many case reports and reviews but few retrospective and prospective trials, showing there is no standard therapeutic approach. In the literature the best therapeutic strategy for limited disease is the multimodality treatment and most authors have extrapolated treatment algorithms from the therapy recommendations of small cell lung cancer. CASE REPORT A 71-year-old male patient was referred to our hospital with gross hematuria and dysuria. Imaging and cystoscopy revealed a vegetative lesion of the bladder wall. A transurethral resection of the bladder was performed. Pathological examination revealed a pT2 high-grade urothelial carcinoma with widespread neuroendocrine differentiation. Multimodal treatment with neoadjuvant platinum-based chemotherapy was performed. A CT scan performed after chemotherapy demonstrated a radiological complete response. The patient underwent radical cystectomy and lymphadenectomy. The histopathological finding of bladder and node specimen confirmed a pathological complete response. A post-surgery CT scan showed no evidence of local or systemic disease. Six months after surgery, the patient is still alive and disease-free. CONCLUSIONS A standard treatment strategy of small cell cancer of the urinary bladder is not yet well established, but a multimodal treatment of this disease is the best option compared to surgical therapy alone. The authors confirm the use of neoadjuvant chemotherapy in limited disease of small cell carcinoma of the urinary bladder.
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Affiliation(s)
- Arsela Prelaj
- Department of Medical Oncology Unit A, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | | | - Fabio Massimo Magliocca
- Department of Gynecology, Obstetrics and Urology, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Iolanda Speranza
- Department of Medical Oncology Unit A, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Emanuele Corongiu
- Department of Gynecology, Obstetrics and Urology, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Giuseppe Borgoni
- Department of Gynecology, Obstetrics and Urology, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Giacomo Perugia
- Department of Gynecology, Obstetrics and Urology, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Marcello Liberti
- Department of Gynecology, Obstetrics and Urology, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Vincenzo Bianco
- Department of Medical Oncology Unit A, Umberto I, ''Sapienza'' University of Rome, Rome, Italy
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Ahmed S, Neufeld S, Kroczak TJ, Bashir B, Ahmed N, Czaykowski P, Aljada I, Koul R, Galloway K, Drachenberg DE. Small Cell Cancer of the Bladder and Prostate: A Retrospective Review from a Tertiary Cancer Center. Cureus 2015; 7:e296. [PMID: 26261754 PMCID: PMC4529331 DOI: 10.7759/cureus.296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/07/2015] [Indexed: 01/06/2023] Open
Abstract
Background: Genitourinary small cell cancer (GUSCC) is a rare malignancy. Most of the published data on how to manage this malignancy is based on institutional experience. We undertook the current retrospective review to determine the outcome of the patients with GUSCC treated at CancerCare Manitoba, Canada over a period of 18 years. Methods: The Manitoba Cancer Registry was used to identify patients with a confirmed pathological diagnosis of small cell cancer (SCC) of the bladder or prostate between January 1, 1995, and October 31, 2013. Results: There were 42 patients identified, 28 bladder SCC (17 limited, 11 extensive stage) and 14 prostate SCC (one limited, 12 extensive, and one unknown stage). The median age was 70.7 years. There were 22 patients who were treated with chemotherapy and radiation, five received radiation only, four received chemo only, nine did not receive any treatment, one patient had surgery only, and one had surgery and radiation. The median and one-year overall survival for all patients was 10.7 months and 43%. The median and one-year overall survival of SCC of the bladder was 55.1 months and 71% for the limited stage and 10.1 months and 36% for the extensive stage. The median and one-year overall survival for extensive stage SCC of the prostate was 4.1 months and 17%. There was only one patient with limited stage SCC of the prostate who did not receive any treatment and died of progressive disease 11 months from diagnosis. Conclusions: Our findings suggest that patients with limited stage SCC of the bladder can have a surprisingly good outcome with multimodality treatment. The outcome of the patients with extensive stage SCC of the bladder and prostate remains dismal and optimal therapeutic options have yet to be determined.
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Affiliation(s)
- Shahida Ahmed
- Radiation Oncology, CancerCare Manitoba, CancerCare Manitoba, University of Manitoba
| | - Sam Neufeld
- Faculty of Health Sciences, College of Medicine, University of Manitoba, Canada
| | | | - Bashir Bashir
- Radiation Oncology, CancerCare Manitoba, University of Manitoba
| | - Naseer Ahmed
- Radiation Oncology, CancerCare Manitoba, University of Manitoba
| | | | | | - Rashmi Koul
- Radiation Oncology, CancerCare Manitoba, University of Manitoba
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Chang K, Dai B, Kong YY, Qu YY, Gan HL, Gu WJ, Ye DW, Zhang HL, Zhu Y, Shi GH. Genitourinary small-cell carcinoma: 11-year treatment experience. Asian J Androl 2015; 16:705-9. [PMID: 24713837 PMCID: PMC4215663 DOI: 10.4103/1008-682x.127811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The predictive factors of prognosis and treatment strategies for small-cell carcinoma (SCC) of the urinary tract are controversial. This study was aimed to investigate the clinical experience and management of patients with SCC of the urinary tract. We collected data of patients who were diagnosed with genitourinary SCC (GSCC) between 2002 and 2013 and were treated in the Fudan University Shanghai Cancer Center. A total of 18 patients were diagnosed with GSCC of which 10 originated from the prostate, seven from the bladder and one from the adrenal gland. The mean follow-up time was 15.5 months and progression-free survival (PFS) was 9.3 months. Primary tumor resection was attempted in 13 of 18 patients (72.2%) in whom radical surgery was performed in six of 14 (42.9%) limited disease patients. Most of the patients (13, 72.2%) received cisplatin-based chemotherapy. Patients who had normal lactic dehydrogenase (LDH) levels showed a significantly higher median PFS and overall survival (OS) compared with patients with high LDH levels (P = 0.030, P= 0.010). Patients with limited disease treated with a radical operation experienced a non-significant (P = 0.211) longer PFS compared with patients who were not treated, but this reached statistical significance after analyzing OS (P = 0.211, P= 0.039). Our patients showed a poor prognosis as reported previously. Serum LDH levels beyond the normal range indicate a poor prognosis. For GSCC patients who are diagnosed with limited disease, radical surgery is strongly recommended along with cisplatin-based chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Ding-Wei Ye
- Department of Urology and Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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Pasquier D, Barney B, Sundar S, Poortmans P, Villa S, Nasrallah H, Boujelbene N, Ghadjar P, Lassen-Ramshad Y, Senkus E, Oar A, Roelandts M, Amichetti M, Vees H, Zilli T, Ozsahin M. Small Cell Carcinoma of the Urinary Bladder: A Retrospective, Multicenter Rare Cancer Network Study of 107 Patients. Int J Radiat Oncol Biol Phys 2015; 92:904-10. [PMID: 26104942 DOI: 10.1016/j.ijrobp.2015.03.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Small cell carcinomas of the bladder (SCCB) account for fewer than 1% of all urinary bladder tumors. There is no consensus regarding the optimal treatment for SCCB. METHODS AND MATERIALS Fifteen academic Rare Cancer Network medical centers contributed SCCB cases. The eligibility criteria were as follows: pure or mixed SCC; local, locoregional, and metastatic stages; and age ≥18 years. The overall survival (OS) and disease-free survival (DFS) were calculated from the date of diagnosis according to the Kaplan-Meier method. The log-rank and Wilcoxon tests were used to analyze survival as functions of clinical and therapeutic factors. RESULTS The study included 107 patients (mean [±standard deviation, SD] age, 69.6 [±10.6] years; mean follow-up time, 4.4 years) with primary bladder SCC, with 66% of these patients having pure SCC. Seventy-two percent and 12% of the patients presented with T2-4N0M0 and T2-4N1-3M0 stages, respectively, and 16% presented with synchronous metastases. The most frequent curative treatments were radical surgery and chemotherapy, sequential chemotherapy and radiation therapy, and radical surgery alone. The median (interquartile range, IQR) OS and DFS times were 12.9 months (IQR, 7-32 months) and 9 months (IQR, 5-23 months), respectively. The metastatic, T2-4N0M0, and T2-4N1-3M0 groups differed significantly (P=.001) in terms of median OS and DFS. In a multivariate analysis, impaired creatinine clearance (OS and DFS), clinical stage (OS and DFS), a Karnofsky performance status <80 (OS), and pure SCC histology (OS) were independent and significant adverse prognostic factors. In the patients with nonmetastatic disease, the type of treatment (ie radical surgery with or without adjuvant chemotherapy vs conservative treatment) did not significantly influence OS or DFS (P=.7). CONCLUSIONS The prognosis for SCCB remains poor. The finding that radical cystectomy did not influence DFS or OS in the patients with nonmetastatic disease suggests that conservative treatment is appropriate in this situation.
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Affiliation(s)
- David Pasquier
- Academic Radiation Oncology Department, Centre Oscar Lambret, Lille, France.
| | | | - Santhanam Sundar
- Department of Oncology, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - Philip Poortmans
- Department of Radiation Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Salvador Villa
- Radiation Oncology, Catalan Institute of Oncology, H. Universitari Germans Trías, Badalona, Barcelona, Spain
| | - Haitam Nasrallah
- Division of Oncology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noureddine Boujelbene
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pirus Ghadjar
- Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland
| | | | - Elżbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Andrew Oar
- Genesis Cancer Care, Southport, Australia
| | | | | | - Hansjoerg Vees
- Department of Radiation Oncology, Hopital de Sion, Sion, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Yazıcı O, Ozdemir NY, Sendur MAN, Aksoy S, Zengin N. Current approaches for prophylactic cranial irradiation in extrapulmonary small cell carcinoma. Curr Med Res Opin 2014; 30:1327-36. [PMID: 24628530 DOI: 10.1185/03007995.2014.904771] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) patients, who have achieved complete or partial response after chemotherapy, should be followed with prophylactic cranial irradiation (PCI). PCI for extrapulmonary small cell carcinoma (EPSCC) is not routinely recommended. The purpose of this review is to discuss all aspects of PCI in management of EPSCC. SCOPE The PubMed database and the database of online abstracts of the American Society of Oncology (ASCO), ASCO Genitourinary (GU) Cancers meetings and clinical trials were searched up to 15 October 2013 using the following search keywords: 'SCC or EPSCC of each organ site and prophylactic cranial radiotherapy'. The language of screened abstracts and manuscripts was limited to English. The papers which included the largest case series and data of cases about prophylactic cranial radiotherapy and/or were published in the last 10 years were selected. FINDINGS Many single center studies showed low incidence of brain metastasis in patients with esophageal small cell carcinoma (SCC). Due to the low incidence of brain metastasis, PCI is not recommended for esophageal SCC. Genitourinary, colorectal, small bowel and appendix cranial metastatic SCCs are extremely rare. Therefore, PCI is not recommended. The frequency of brain metastasis of prostate small cell carcinoma is much higher (16-19%) compared to other counterparts of EPSCC. PCI can be performed in selected cases of prostate SCC. High rates (41%) of brain metastasis develop in head and neck SCC. PCI should be considered for patients with head neck SCC. CONCLUSION In the literature, the brain metastasis incidence of EPSCC might vary from 1.7% up to 40%. In many patients with ESPCC, PCI is not recommended. However, we have to keep in mind that primary head and neck and prostate SCC are exceptions due to the high incidence of cranial metastasis; PCI should be recommended for these patients on an individual basis.
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Affiliation(s)
- Ozan Yazıcı
- Ankara Numune Education and Research Hospital , Ankara , Turkey
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de Vasconcellos VF, Trancoso JLL, Felipe-Silva A, Simões AB, Dos Santos PJ, Fugita OEH, Ono CR, Buchpiguel CA. Unusual presentation of high-grade neuroendocrine carcinoma of the Urinary bladder with small-cell and large-cell features. AUTOPSY AND CASE REPORTS 2013; 3:67-75. [PMID: 31528620 PMCID: PMC6671890 DOI: 10.4322/acr.2013.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/14/2013] [Indexed: 12/02/2022] Open
Abstract
High-grade neuroendocrine carcinoma of the urinary bladder comprehends small-cell and large-cell variants. It is a rare and aggressive neoplasm, mostly diagnosed in advanced stages. It is more frequently encountered among Caucasian men in the sixth decade of life. Urinary symptoms are the most common clinical presentation. Diagnosis is generally not troublesome once the lesions are easily detectable by imaging exams and cystoscopy. This neoplasia is associated with tobacco smoking, and is frequently associated with other carcinomatous components such as urothelial carcinoma, adenocarcinoma, and sarcomatoid carcinoma. The authors report a case of an apparently healthy female patient who presented cervical lymph node enlargement not accompanied by systemic symptoms. The supraclavicular lymph node biopsy revealed metastatic small cell carcinoma. The computed tomography scan showed a bladder wall nodular thickening, enlarged lymph nodes along the iliac, periaortic, mediastinal, cervical and supraclavicular chains, as well as an insufflating lytic bone lesion in the right iliac wing. The positron emission tomography-fluorodeoxyglucose (PET-FDG) added to these findings, the presence of a paraesophageal lymph node, lymphadenomegaly in the gluteal region and a vertebral lytic lesion in T10. Resected specimen of the bladder tumor revealed a high-grade neuroendocrine carcinoma with small-cell and large-cell features.
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Affiliation(s)
- Vitor Fiorin de Vasconcellos
- Department of Internal Medicine, Hospital das Clínicas, Faculdade de Medicina,Universidade de São Paulo, São Paulo/SP - Brazil
| | - João Lapa Lima Trancoso
- Department of Internal Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Anatomic Pathology Service, Hospital Universitário, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Angélica Braz Simões
- Anatomic Pathology Service, Hospital Universitário, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Pedro José Dos Santos
- Diagnostic Imaging Service, Hospital Universitário, Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Carla Rachel Ono
- Institut of Radiology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
| | - Carlos Alberto Buchpiguel
- Institut of Radiology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP - Brazil
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