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An Orthotopic Bladder Tumor Model and the Evaluation of Intravesical saRNA Treatment
Published on: July 28, 2012
Treatment of muscle invasive bladder cancer. Is there a role for neoadjuvant chemotherapy?
1Northern Israel Oncology Center, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Purpose:
Because 5-year survival with advanced bladder cancer is still poor, the search for optimal treatment continues as dose the necessity of clarifying goals of treatment.
Patients And Methods:
We compared the outcome of 3 different but widely accepted treatment protocols for bladder cancer in order to find which, if any, was superior, with particular emphasis upon the performance of the newest treatment, neoadjuvant chemotherapy. Data on 224 bladder patients treated at our institution (1975 to 1991) with 1 of the 3 protocols was analyzed. Those protocols were: 1. radiotherapy > 60 Gy (143 patients); 2. low dose radiotherapy followed by cystectomy (25 patients); 3. chemotherapy followed by either definitive radiotherapy or surgery (56 patients). Because the latter group was also a chronologically newer group with a shorter possible follow-up, we compared all treatments on the basis of 2-year survival, using Kaplan-Meier life tables. We briefly reviewed those modalities which are bladder-sparing because of the significance to quality of life of this factor.
Results:
Two-year survival figures for the patients were: 63% for those who received only radiotherapy; 72% for those undergoing cystectomy: 68% for the group to whom neoadjuvant chemotherapy was administered. The differences were not statistically significant. However, 23% of those patients treated neoadjuvantly were alive with intact bladders at 2 years.
Conclusion:
These results do not suggest that a superior survival advantage is associated with any of these 3 protocols and neoadjuvant chemotherapy, in particular, cannot be seen as conferring a new and important survival advantage. However, neoadjuvant chemotherapy followed by radiotherapy does permit bladder conservation and, given that life span will often be reduced, the importance of helping to keep the remainder of the patient's life as comfortable as possible, can hardly be overestimated.
Insights
Comparing three bladder cancer treatments, this study found no significant survival differences. Neoadjuvant chemotherapy, however, allowed for bladder preservation in 23% of patients, improving quality of life.
Area of Science:
- Oncology
- Urology
- Cancer Treatment Research
Background:
- Advanced bladder cancer survival rates remain poor, necessitating ongoing research into optimal treatment strategies.
- Clarifying treatment goals is crucial for managing advanced bladder cancer.
Purpose of the Study:
- To compare the outcomes of three established bladder cancer treatment protocols.
- To evaluate the efficacy of neoadjuvant chemotherapy as a newer treatment modality.
Main Methods:
- Analysis of data from 224 bladder cancer patients treated between 1975 and 1991.
- Comparison of three protocols: radiotherapy (>60 Gy), low-dose radiotherapy with cystectomy, and neoadjuvant chemotherapy followed by radiotherapy or surgery.
- Two-year survival rates were assessed using Kaplan-Meier life tables.
Main Results:
- Two-year survival rates were 63% (radiotherapy), 72% (cystectomy), and 68% (neoadjuvant chemotherapy).
- No statistically significant differences in survival were observed between the treatment groups.
- A notable finding was that 23% of patients receiving neoadjuvant chemotherapy survived with their bladders intact at two years.
Conclusions:
- None of the three evaluated treatment protocols demonstrated a superior survival advantage for advanced bladder cancer.
- Neoadjuvant chemotherapy, while not improving survival, offers the significant benefit of bladder conservation.
- Bladder preservation is important for maintaining patient quality of life, especially when overall lifespan may be limited.
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