title: Outcome of patients with nonmetastatic muscle-invasive bladder cancer not undergoing cystectomy after treatment with noncisplatin-based chemotherapy and/or radiotherapy: a retrospective analysis.
abstract: Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle-invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin-based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin-based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty-nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin-based chemotherapy (n = 25), carboplatin-based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five-year event-free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression-free survival, and 30 (SE = 8) for cancer-specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5-year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit-for-cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated.
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece.
authors.forename: Aristotle
authors.initials: A
authors.lastname: Bamias
authors.affiliation: Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Petros
authors.initials: P
authors.lastname: Tsantoulis
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zilli
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|2nd Department of Urology, University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papatsoris
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Francesca
authors.initials: F
authors.lastname: Caparrotti
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|2nd Department of Urology, University of Athens, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Kyratsas
authors.affiliation: Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece.
authors.forename: Kimon
authors.initials: K
authors.lastname: Tzannis
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|1st Department of Urology, University of Athens, Athens, Greece.
authors.forename: Kostas
authors.initials: K
authors.lastname: Stravodimos
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|2nd Department of Urology, University of Athens, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Chrisofos
authors.affiliation: Department of Urology Department, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wirth
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|2nd Department of Urology, University of Athens, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Skolarikos
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|1st Department of Urology, University of Athens, Athens, Greece.
authors.forename: Dionysios
authors.initials: D
authors.lastname: Mitropoulos
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|1st Department of Urology, University of Athens, Athens, Greece.
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Constantinides
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|2nd Department of Urology, University of Athens, Athens, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Deliveliotis
authors.affiliation: Department of Urology Department, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Christophe E
authors.initials: CE
authors.lastname: Iselin
authors.affiliation: Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Raymond
authors.initials: R
authors.lastname: Miralbell
authors.affiliation: Department of Oncology and Centre de Recherche Clinique Dubois Ferrari, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Dietrich
authors.affiliation: Hellenic Genito-Urinary Cancer Group, Athens, Greece.|Department of Clinical Therapeutics, Medical School, Athens University, Athens, Greece.
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015897:Comorbidity; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*
keywords: Bladder cancer; multimodality treatment; unfit for cisplatin