Long-Term Outcomes Among Patients Who Achieve Complete or Near-Complete Responses After the Induction Phase of Bladder-Preserving Combined-Modality Therapy for Muscle-Invasive Bladder Cancer: A Pooled Analysis of NRG Oncology/RTOG 9906 and 0233

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• 作者：Timur Mitin ; MD^&lowast ; ; ^{mitin@ohsu.edu" class="auth_mail" title="E-mail the corresponding author} ; Asha George ; MS^&dagger ; ; Anthony L. Zietman ; MD^&Dagger ; ; Niall M. Heney ; MD^&Dagger ; ; Donald S. Kaufman ; MD^&Dagger ; ; Robert G. Uzzo ; MD^§ ; ; Robert Dreicer ; MD^‖ ; H. James Wallace III ; MD^¶ ; ; Luis Souhami ; MD^# ; M. Chris Dobelbower ; MD^&lowast ; &lowast ; ; Howard M. Sandler ; MD^&dagger ; &dagger ; ; William U. Shipley ; MD^&Dagger ;
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：94
• 期：1
• 页码：67-74
• 全文大小：465 K

文摘

To investigate the differences in outcomes among patients with muscle-invasive bladder cancer on NRG Oncology Radiation Therapy Oncology Group protocols 9906 and 0233 who achieved complete response and near-complete response after induction chemoradiation and then completed bladder-preserving therapy with chemoradiation therapy (chemo-RT) to full dose (60-64 Gy).

Patients and Methods

A pooled analysis was performed on 119 eligible patients with muscle-invasive bladder cancer enrolled on NRG Oncology Radiation Therapy Oncology Group trials 9906 and 0233, who were classified as having a complete (T0) or near-complete (Ta or Tis) response after induction chemo-RT and completed consolidation with a total RT dose of at least 60 Gy. Bladder recurrence, salvage cystectomy rates, and disease-specific survival were estimated by the cumulative incidence method and bladder-intact and overall survivals by the Kaplan-Meier method.

Results

Among the 119 eligible patients, 101 (85%) achieved T0, and 18 (15%) achieved Ta or Tis after induction chemo-RT and proceeded to consolidation. After a median follow-up of 5.9 years, 36 of 101 T0 patients (36%) versus 5 of 18 Ta or Tis patients (28%) experienced bladder recurrence (P=.52). Thirteen patients among complete responders eventually required late salvage cystectomy for tumor recurrence, compared with 1 patient among near-complete responders (P=.63). Disease-specific, bladder-intact, and overall survivals were not significantly different between T0 and Ta/Tis cases.

Conclusions

The bladder recurrence and salvage cystectomy rates of the complete and the near-complete responders were similar. Therefore it is reasonable to recommend that patients with Ta or Tis after induction chemo-RT continue with bladder-sparing therapy with consolidation chemo-RT to full dose (60-64 Gy).