Background and Objectives: There is no consensus regarding the optimal therapy sequence in stage II and III bladder cancer. The study aimed to evaluate the long-term oncologic outcomes in patients with bladder cancer after a multimodality approach. Materials and methods: Medical files of 231 consecutive patients identified with stage II (46.8%), IIIA (30.3%), and IIIB (22.9%) transitional cell carcinoma of the bladder (BC) treated with a multimodality approach were retrospectively reviewed. The treatment consisted of transurethral resections or cystectomy, radiotherapy alone or concurrent chemoradiotherapy as definitive treatment, or neoadjuvant chemotherapy using platinum salt regimens. Results: Median age at diagnosis was 65 ± 10.98 years. Radical or partial cystectomy was performed in 88 patients (37.1%), and trans-urethral resection of bladder tumor (TURBT) alone was performed in 143 (61.9%) patients. Overall, 40 patients (17.3%) received neoadjuvant chemotherapy and 82 (35.5%) received definitive chemoradiotherapy. After a median follow-up of 30.6 months (range 3-146 months), the median disease-free survival (DFS) for an entire lot of patients was 32 months, and the percentage of patients without recurrence at 12, 24, and 36 months was 86%, 58%, and 45%, respectively. Patients receiving neoadjuvant chemotherapy had a better oncologic outcome compared to patients without neoadjuvant chemotherapy (median DFS not reached vs. 31 months, p = 0.038, HR = 0.55, 95% CI 0.310-0.951). There was a trend for better 3-year DFS with radical cystectomy vs. TURBT (60 months vs. 31 months, p = 0.064). Definitive chemoradiotherapy 3-year DFS was 58% compared to 44% in patients who received radiotherapy or chemotherapy alone. Conclusions: In patients with stages II and III, both neoadjuvant chemotherapy and concurrent radio-chemotherapy are valid options for treatment and must be part of a multidisciplinary approach.
Medicina (Kaunas, Lithuania). 2022 Dec 27*** epublish ***
Oana Gabriela Trifanescu, Laurentia Nicoleta Gales, Mihai Andrei Paun, Natalia Motas, Serban Andrei Marinescu, Ion Virtosu, Raluca Alexandra Trifanescu, Mirela Gherghe, Liviu Bilteanu, Camelia Cristina Diaconu, Rodica Maricela Anghel
Department of Oncology, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania., Institute of Oncology "Prof. Dr. Al. Trestioreanu" Bucharest, Radiotherapy II, 022328 Bucharest, Romania., Institute of Oncology "Prof. Dr. Al. Trestioreanu" Bucharest, Thoracic Surgery, 022328 Bucharest, Romania., Institute of Oncology "Prof. Dr. Al. Trestioreanu" Bucharest, Oncologic Surgery I, 022328 Bucharest, Romania., Institute of Endocrinology "C. I Parhon", 011863 Bucharest, Romania., Institute of Oncology "Prof. Dr. Al. Trestioreanu" Bucharest, Nuclear Medicine, 022328 Bucharest, Romania., Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.