Treatment Of Muscle-invasive Cancer Research Articles

Diagnosis and treatment of octogenarian neoplastic patients: bladder cancers

Age is a risk factor for the occurrence of bladder cancer and bladder cancer is a disease of the elderly. The choice of treatment relays on the staging into non-invasive and muscle-invasive bladder cancer. Non-invasive bladder cancer is usually treated with transurethral resection of the bladder (TURB) followed by intravesical therapy with BCG or chemotherapeutic agents. The gold standard in the treatment of muscle-invasive bladder cancer is radical cystectomy. The elderly and, in particular, the octogenarian have a worse tolerance for aggressive therapies, due to the higher incidence of side effects and complications. This problem could significantly occur for intravesical BCG therapy and for radical cystectomy. When the urologist faces the treatment of an octogenarian affected by bladder cancer, he should answer many questions: 1. In case of a non-invasive bladder cancer, is it possible to use the same drugs that we use for younger patients (BCG vs chemotherapeutic agents)? Should the timing and the kind of follow-up be the same? 2. Should the octogenarian affected by muscle-invasive bladder cancer undergo radical cystectomy or a less invasive treatment? What kind of diversion should be preferred? Is it possible to propose an orthotopic neobladder to an octogenarian patient? The choice of the treatment should be made on the basis of a careful evaluation of the patient, considering not only the patient's age but also comorbidities and life expectancy.

Effect of bladder preserving surgery combined with internal iliac artery infusion chemotherapy for the treatment of muscle invasive bladder cancer

Objectives To investigate the clinical effect of adjuvant internal iliac artery infusion in patients with muscle invasive bladder cancer after resection of bladder tumor. Methods 84 patients with muscle invasive bladder cancer who refused to accept or not accept bladder resection were selected as the object of study from January 2012 to January 2015 in the hospital. All patients underwent transurethral resection of bladder tumor(TURBT), who were divided into two groups after operation, the control group (40 cases with systemic chemotherapy), the experimental group (44 cases with internal iliac artery infusion chemotherapy). Bladder retention rate, adverse drug reaction, HIF - 1 alpha, VEGF positive rate and 3-year survival rate were compared between the two groups. Results The positive rate of the patients in the two groups decreased significantly after treatment and experimental group of HIF - 1 alpha and VEGF positive rate was 45.5%, 36.4%, significantly lower than control group of 65.0% and 52.5%, there was statistically significant difference between the two groups(P<0.05). In the control group, the incidence of complications was 45.0%, the experimental group complications occurrence rate was 25.0%, the difference between the two groups were obvious(P<0.05).1-year follow-up of bladder retention rate of the control group was 60.0% and the experimental group was 81.8%, the difference was statistically significant(P<0.05). 3-year survival rate of the experimental group was 70.5%, and the control group was 52.5%, there was statistical significance difference between the two groups(P<0.05). Conclusions The effect of internal iliac artery infusion chemotherapy in patients with muscle invasive bladder cancer is better, and it is suitable for clinical promotion. Key words: Bladder Neoplasms; Electrosurgery; Infusion

Effect of transurethral plasmakinetic resection combined with neoadjuvant chemotherapy in the treatment of senile muscle-invasive bladder cancer and quality of life

Objectives To investigate efficacy of transurethral plasmakinetic resection of bladder tumor (PKRBT) combined with neoadjuvant chemotherapy in the treatment of senile muscle-invasive bladder cancer. Methods In our hospital, 83 patients with senile muscle-invasive bladder cancer who chose to retain their bladders from June 2008 to June 2012 were selected.All patients were divided into group A (transurethral plasmakinetic resection combined with neoadjuvant chemotherapy) and group B (PKRBT) according to different therapies. Total response rate, complete response rate, partial response rate, disease stable rate, disease progressive rate and quality of life after one month were compared between the two groups. Results ① Total response rate of group A and group B was 55.81% and 32.5% respectively, clinic benefit rate of group A and group B was 79.07% and 62.5% respectively.There were statistical significant differences in efficacy between the two groups (P 0.05), which indicated that neoadjuvant chemotherapy had no effect on operation and occurrence rate of postoperative complications. ③ Living quality conditions in group A were as follows in postoperative 1 month: good(60.47%), common(25.58%), poor(13.95%), and in group B were good(35.00%), common(37.5%), poor (27.5%). There was statistical significant difference between the groups(P<0.05). Conclusions PKRBT combined with neoadjuvant chemotherapy is a safe and effective therapy, it is worth to be popularized for bladder retaining treatment. Key words: Urinary Bladder Neoplasms; Electrosurgery; Urethra; Chemotherapy, Adjuvant; Quality of Life

Renal Function Preserved in Bladder-sparing Treatment for Muscle-Invasive Cancer

Renal Function Preserved in Bladder-sparing Treatment for Muscle-Invasive Cancer

Clinical observation of radical transurethral photoselective vaporization of bladder tumours combined with chemotherapy in treating muscle invasive bladder cancer

Objective To explore the safety and clinical efficacy of radical transurethral photoselective vaporization of bladder tumours (RPVBT) combined with chemotherapy in the treatment of muscle invasive bladder cancer. Methods Collected during Sept. 2010 to Sept. 2012, a total of 34 patients with muscle invasive bladder cancer who refuse or older, merge the heavier medical disease, difficult to tolerate radical cystectomy.Using RPVBT, vaporization resection to the bladder wall fat layer, postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of pharmorubicin. The operation time、the first recurrent time and recurrent rate, and the survival rate were measured. Results Operation are completed smoothly, operating time is 30.5–69.0 min and average 49.2 min, intraoperative rinses quantity is 5.9–10.7 L and average 8.3 L. Intraoperative no obvious bleeding, intraoperative no serioue complications, postoperative pathological diagnosis is invasive epithelial cell carcinoma of the urinary tract, pathology classification: low level 15cases, the high level 19 cases. Follow–up of 12 to 36 months, an average of 21 months, 9 cases of recurrence, 2 cases underwent radical cystectomy, 7 cases again RPVBT, the first tumor recurrence time 3–20 months, 11 months and the median time to relapse recurrence rate 26.5% (9/34), 3 cases of relapses diedof bladder cancer metastasis, 31 cases of survival. Conclusion Treatment of RPVBT combination chemotherapy in patients with locally invasive bladder cancer, small trauma, less bleeding, high safety, have certain curative effect, It could be a effective treatment strategy for patients of high–risk elderly or unwilling to accept Radadical cystectomy. Key words: Muscleinvasive bladder cancer; Radical; Photoselective vaporization

Combination of intraarterial chemotherapy, three dimensional conformal radiotherapy and transurethral photoselective vaporization for the treatment of muscle-invasive bladder cancer

Objective To evaluate the efficacy of bladder preservation treatment by combining intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization for muscle-invasive bladder cancer.Methods A total of 16 patients (13 males and 3 females; mean age,74 years; age range,68-86 years) with muscle-invasive bladder cancer underwent bladder preservation treatment,who refused or could not tolerate the radical cystectomy (11 cases with cardiovascular and cerebrovascular disease,3 cases with severe chronic obstructive pulmonary disease and other 2 cases refused radical cystectomy as initial therapeutic option).The tumor stages were T2(9 cases),T3(7 cases) and tumor grades were G1(3 cases),G2(10 cases) and G3(3 cases).The mean diameter of tumor was 3.5 cm (range from 3 cm to 6 cm).They received intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization.The chemotherapy regimen consisted of cisplatin 80 mg and pirarubicin 40 mg.The average dose of radiotherapy was 30-40 Gy.Results After intraarterial chemotherapy and three dimensional conformal radiotherapy,all the tumors were necrosis and dwindled significantly and 5 patients showed a complete response.The patients were follow up for 3-43 months after transurethral photoselective vaporization of the residual tumor.Recurrent non-muscle invasive tumors were found in 2 patients and were treated transurethrally.Overall,2 patients died of cerebrovascular accident.Conclusion Combination of intraarterial chemotherapy,three dimensional conformal radiotherapy and transurethral photoselective vaporization is safe and effective for the treatment of muscle-invasive bladder cancer. Key words: Urinary bladder neoplasms; Intraarterial chemotherapy; Three dimensional conformal radiotherapy; Photoselective vaporization

Gemcitabine plus cisplatin neoadjuvant chemotherapy with radical cystectomy for the treatment of muscle invasive bladder cancer: 9 years retrospective analysis

Objective To assess the value of gemcitabine plus cisplatin (GC) neoadjuvant chemotherapy with radical cystectomy in the treatment of patients with muscle invasive bladder cancer (MIBC).Methods The data of 114 patients with MIBC received GC neoadjuvant chemotherapy with radical cystectomy from December 2003 to December 2012 were retrospectively compared with those in other 120 patients treated with radical cystectomy alone from June 2003 to December 2012 in our institution.There was no significant difference of the gender,age and stage between the 2 groups (P＞0.05).The duration of free survival,overall survival and the local control of tumor in different groups were compared.Results In the chemotherapy group,76 cases were found downstaging of the tumor after the operation,including 27 cases with tumor free.The mean duration of following up was (51 ±25) months.Forty-three patients died during the follow-up period.The median survival was 79 months and the 2-year recurrence free rate was 75.9％.In surgery alone group,23 cases were found downstaging of the tumor,including 5 cases with tumor free.The patients were followed up for (38±20) months.Fifty-seven patients died during the following up.The median survival was 44 months and the 2-year recurrence free rate was 62.8％.There were significant differences in downstaging rate of the tumor,recurrence free survival and overall survival between the 2 groups (P＜0.05).Conclusion GC neoadjuvant chemotherapy can improve survival of the patients with MIBC,which facilitate to downstage the tumor and increase the recurrence free survival duration and overall survival duration. Key words: Urinary bladder neoplasms; Muscle invasive; Antineoplastic combined chemotherapy protocols; Neoadjuvant chemotherapy; Gemcitabine plus cisplatin

Outcomes of radical TURBt plus chemotherapy for the treatment of the patients with muscle-invasive bladder cancer

Objective To evaluate the efficacy of radical transurethral bladder tumor resection plus chemotherapy for the treatment of muscle-invasive bladder cancer. Methods Thirty-two patients,who were diagnosed muscle-invasive bladder cancer by preoperative CT and cystoscopy and not tolerating or rejecting radical cystectomy were treated by transurethral resection of bladder tumor (TURBt).The maximum diameter of tumor ranged from 1 - 5 cm,3 cm on average.After conventional intravenous chemotherapy ( docetaxel 75 mg/m2 + oxaliplatin 130 mg/m2),and given intravenous therapy (HCPT 20 mg + 20 ml saline).Regular cystoscopy was used to monitor tumor recurrence.The examination was performed quarterly in the first 2 years post operation,twice a year since the third year. Results The tumors of 32 cases were resected completely.Operative time were 15 -70 min,the blood loss was 10 -150 ml,without serious complications during the operation.Pathological report showed 32 cases of transitional cell carcinoma.Clinical stages were T2a 20 cases,T2b 12 cases.Pathological grade were G2 13 cases,G3 19 cases.There was no bone marrow suppression,anemia or other severe complications was seen in 32 cases that received chemotherapy.3 of which manifested as low fever,mild nausea,and headache,respectively,having a rest 2 to 3 days the symptoms disappeared.32 patients were followed up for 3 - 60 months,a mean of 28 months.After 1 year the recurrence rate was 9.4％ (3/32),after 2 years was 12.5％ (4/32).The TNM stage of these recurrence cases were 4 cases with T2a and 3 cases with T2b.12 patients died,5 patients died of bladder cancer metastasis.Other 20 patients were survival with no recurrence. Conclusion Radical TURBt plus chemotherapy could be a treatment for the selected patients with muscle invasive bladder cancer. Key words: Bladder neoplasms; Transurethral resection; Chemotherapy; Perfusion, regional

Current and Emerging Strategies for the Management of Bladder Cancer

Treatment strategies and outcome of bladder cancer depend on tumor progression. Non-muscle invasive urothelial cell carcinoma (NMI-UCC) is generally treated by transurethral resection (TUR). In addition, intravesical therapy is often followed to prevent the recurrence; however, its effect is not still enough. On the other hand, the prognosis of bladder cancer patients with muscle-invasive and/or metastatic tumors is poor, despite the availability of various therapies. Although radical cystectomy is the gold standard for patients with muscle-invasive disease, high frequency of recurrence and decreased quality of life are major disadvantages associated with this procedure. In recent years, various newly developed treatment strategies have progressed to clinical trials for the perioperative treatment of muscle-invasive cancer and for systematic therapy for advanced bladder cancer. Here, we review the current and emerging therapeutic strategies and discuss the recent clinical trials of anti-vascular endothelial growth factor (VEGF) family- and anti-endothelial growth factor receptor (EGFR)-based therapies.