The Impact of Radiotherapy Facility Volume on the Survival and Guideline Concordance of Patients With Muscle-invasive Bladder Cancer Receiving Bladder-preservation Therapy

Objectives: Higher facility surgical volume predicts for improved outcomes in patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy. We investigated the association between facility radiotherapy (RT) case volume and overall survival (OS) for patients with MIBC who received bladder-preserving RT, and the relationship with adherence to National Comprehensive Cancer Network (NCCN) guidelines for bladder preservation. Methods: The National Cancer Database was used to identify patients diagnosed with nonmetastatic MIBC from 2004 to 2015 and received RT at the reporting center. Facility case volume was defined as the total MIBC patients treated with RT during the period. Facilities were stratified into high-volume facility (HVF) or low-volume facility at the 80th percentile of RT case volume. OS was assessed using Kaplan-Meier analysis. Rates of compliance with NCCN guidelines regarding the use of transurethral resection of the bladder tumor before RT, planned use of concurrent chemotherapy, and total RT dose were compared. Cox proportional hazard model was used to evaluate predictors of OS. Results: There were 7562 patients included. No differences in age, Charlson-Deyo score, T stage, or node-positive rates were observed between groups. HVFs exhibited greater compliance with NCCN guidelines for bladder preservation (P
Source: American Journal of Clinical Oncology - Category: Cancer & Oncology Tags: Original Articles: Genitourinary Source Type: research

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In this study, we found that pirarubicin (THP), one important chemotherapeutic drug for treating bladder cancer intravesically, dramatically elevated phosphorylations of both Akt and Erk1/2 in addition to inducing DNA damage. MK2206 or AZD6244, representative Akt and Erk1/2 inhibitors, respectively, profoundly sensitized bladder cancer cells to THP treatment. Interestingly, we found that inhibition of a single arm of either Akt or Erk1/2 pathway would induce the increase of another arm, indicating the existence of the crosstalk between these two pathways. Thus, simultaneous suppression of both signals may be needed for inc...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Abstract OBJECTIVES: Overexpression of aurora kinase A (AURKA) confers a poor prognosis in patients with urothelial carcinoma of the bladder. The prognostic value of high aurora kinase B (AURKB) expression in local bladder cancer is not well defined, and whether the prognostic value of either AURKA or AURKB is affected by the use of chemotherapy is unknown. We sought to characterize the impact of high AURKA and AURKB expression on clinical outcome in patients with muscle-invasive bladder cancer (MIBC) who received neoadjuvant chemotherapy (NAC). MATERIALS AND METHODS: Immunohistochemistry for AURKA and AURKB ...
Source: Urologic Oncology - Category: Urology & Nephrology Authors: Tags: Urol Oncol Source Type: research
We examined the clinical outcomes of such patients and developed a risk prediction model to facilitate risk-stratification and management. METHODS: We identified adult patients with cTany cN1-3 M0 urothelial carcinoma of the bladder treated with chemotherapy followed by RC from 2006 to 2013 in the NCDB. The associations of clinicopathologic features with overall survival (OS) were evaluated using Cox regression, and a simplified risk score was developed. RESULTS: A total of 491 patients received chemotherapy followed by RC. Median number of lymph nodes removed was 16 (interquartile range 9-25). At RC, 10% of pati...
Source: Urologic Oncology - Category: Urology & Nephrology Authors: Tags: Urol Oncol Source Type: research
"Watch and Wait" for complete clinical response after neoadjuvant chemoradiotherapy for rectal cancer. Minerva Chir. 2019 Sep 30;: Authors: Peacock O, Chang GJ Abstract The management of rectal cancer has evolved substantially over recent decades, becoming increasingly complex. This was once a disease associated with high mortality and limited treatment options that typically necessitated a permanent colostomy, has now become a model for multidisciplinary evaluation, treatment and surgical advancement. Despite advances in the rates of total mesorectal excision, decreased local recurrence and ...
Source: Minerva Chirurgica - Category: Surgery Tags: Minerva Chir Source Type: research
We describe the case of a 74 year old woman with previous history of gastric signet cell carcinoma who develops bladder metastasis as first sign of recurrence 6 years later. Bladder metastasis due to signet cell carcinoma is extremely rare with only 19 cases reported. Treatment includes radical cystectomy or chemotherapy.
Source: Urology - Category: Urology & Nephrology Authors: Source Type: research
CONCLUSIONS: Chronological age should not be a contraindication for applying standard therapies in NMIBC. In MIBC the survival is low regardless of the type of management. The lack of correlation between OS and ASA or Charlson-score raises the necessity of a geriatric assessment for selecting the best treatment strategy. PMID: 31586544 [PubMed - as supplied by publisher]
Source: Urologic Oncology - Category: Urology & Nephrology Authors: Tags: Urol Oncol Source Type: research
ConclusionsThe results demonstrate that robotic-assisted TME for patients with rectal cancer after neoadjuvant CCRT (concurrent chemoradiotherapy) is effective and for patient with tumor invaded to bladder, prostate or uterus, neoadjuvant chemotherapy is a safe and effective way for organ-preserving instead of salvage surgery.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundIntroduction of checkpoint inhibitors (anti PD-1/PD-L1) have resulted in improved survival for bladder cancer patients, however, only a subset will benefit. The utility of PD-L1 expression as a prognostic or predictive biomarker is limited, motivating the search for more robust biomarkers. Here, we examined the prognostic value of densities of PD-L1, CD3, CD8 or CD68 positive cells and studied the reproducibility of the findings across two patient cohorts in a multi-assay and multicentre setting.MethodsMIBC specimens (T stage 2/3) from two patient cohorts collected at Melbourne, Australia (n  =&thi...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
ConclusionsSelPac met its primary endpoint, demonstrating a statistically significant improvement in PFS for SEL + PT without a significant increase in toxicity. No trend for a prolongation of OS was observed.Clinical trial identificationISRCTN 29621851.Legal entity responsible for the studyUniversity of Liverpool&Liverpool Cancer Trials Unit.FundingCancer Research UK and AstraZeneca.DisclosureP. Nathan: Honoraria (self), Advisory / Consultancy, Consultancy / advisory board: AstraZeneca; Honoraria (self), Advisory / Consultancy, Consultancy / advisory board: BMS; Honoraria (self), Advisory / Consultancy, Consultancy / ...
Source: Annals of Oncology - Category: Cancer & Oncology Source Type: research
Conclusion: Neoadjuvant chemotherapy utilization continues to slowly increase in patients with MIBC. Patients with variant histology lag behind in terms of receiving NAC but appear to derive as much benefit as patients with pure urothelial cell bladder cancer.
Source: Indian Journal of Urology - Category: Urology & Nephrology Authors: Source Type: research
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