Five-year Followup of a Prospective Trial of Radical Cystectomy and Neoadjuvant Chemotherapy: Nordic Cystectomy Trial 1

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No AccessJournal of UrologyClinical Urology: Original Article1 Jun 1996Five-year Followup of a Prospective Trial of Radical Cystectomy and Neoadjuvant Chemotherapy: Nordic Cystectomy Trial 1 Per-Uno Malmstrom, Erkki Rintala, Rolf Wahlqvist, Pekka Hellstrom, Sverker Hellsten, and Einar Hannisdal Per-Uno MalmstromPer-Uno Malmstrom More articles by this author , Erkki RintalaErkki Rintala More articles by this author , Rolf WahlqvistRolf Wahlqvist More articles by this author , Pekka HellstromPekka Hellstrom More articles by this author , Sverker HellstenSverker Hellsten More articles by this author , and Einar HannisdalEinar Hannisdal More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)66042-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Chemotherapy is widely used in patients with locally advanced bladder cancer but until now there has been no conclusive evidence that this therapy improves survival. The Nordic Cooperative Bladder Cancer Study Group conducted a randomized phase III study to assess the possible benefit of neoadjuvant chemotherapy in patients with bladder cancer undergoing radical cystectomy after short-term radiotherapy. Materials and Methods: Our trial included 325 patients with locally advanced stage T1 grade 3 or stages T2 to T4aNXMO bladder cancer allocated randomly into a chemotherapy or no chemotherapy group (control). The chemotherapy schedule consisted of 2 cycles of 70 mg./m.2 cisplatin and 30 mg./m.2 doxorubicin with a 3-week interval between the cycles. Results: After 5 years the overall survival rate was 59 percent in the chemotherapy group and 51 percent in the control group (p = 0.1). The corresponding cancer specific survival rate was 64 and 54 percent, respectively. In regard to treatment, no difference was observed for stages T1 and T2 disease, while there was a 15 percent difference in overall survival for patients with stages T3 to T4a disease (p = 0.03). In a multivariate analysis only chemotherapy and T category emerged as independent prognostic factors. The relative death risk for patients who received chemotherapy was 0.69 (95 percent confidence interval 0.49 to 0.98) compared to the control group after adjustment for the other tested factors. Conclusions: Neoadjuvant chemotherapy seems to improve long-term survival after cystectomy in patients with stages T3 to T4a bladder carcinoma, while no survival benefit was found for stages T1 to T2 disease. References 1 : Current management of invasive and metastatic transitional cell carcinoma of the bladder. J. Urol.1993; 149: 957. Link, Google Scholar 2 : Radical cystectomy and adjuvant chemotherapy. Urology1985; 25: 151. 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Google Scholar From the Departments of Urology, University Hospital Uppsala, Uppsala, and University Hospital, Malmo, Sweden, Helsinki University Central Hospital, Helsinki and Oulu University Hospital, Oulu, Finland, and Ulleval sykehus, Oslo, and Clinical Research Office, Norwegian Radium Hospital, Oslo, Norway.© 1996 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byFischer-Valuck B, Rao Y, Rudra S, Przybysz D, Germino E, Samson P, Baumann B, Gay H and Michalski J (2017) Treatment Patterns and Overall Survival Outcomes of Octogenarians with Muscle Invasive Cancer of the Bladder: An Analysis of the National Cancer DatabaseJournal of Urology, VOL. 199, NO. 2, (416-423), Online publication date: 1-Feb-2018.Traboulsi S and Kassouf W (2015) A Review of Neoadjuvant and Adjuvant Chemotherapy for Nonmetastatic Muscle Invasive Bladder CancerUrology Practice, VOL. 3, NO. 1, (41-49), Online publication date: 1-Jan-2016.North S, El-Gehani F, Santos C, Ghosh S, Lai R, Cass C and Mackey J (2013) Expression of Nucleoside Transporters and Deoxycytidine Kinase Proteins in Muscle Invasive Urothelial Carcinoma of the Bladder: Correlation with Pathological Response to Neoadjuvant Platinum/Gemcitabine Combination ChemotherapyJournal of Urology, VOL. 191, NO. 1, (35-39), Online publication date: 1-Jan-2014.Mertens L, Fioole-Bruining A, van Rhijn B, Kerst J, Bergman A, Vogel W, Vegt E and Horenblas S (2012) FDG-Positron Emission Tomography/Computerized Tomography for Monitoring the Response of Pelvic Lymph Node Metastasis to Neoadjuvant Chemotherapy for Bladder CancerJournal of Urology, VOL. 189, NO. 5, (1687-1691), Online publication date: 1-May-2013.Mertens L, Meijer R, Kerst J, Bergman A, van Tinteren H, van Rhijn B and Horenblas S (2012) Carboplatin Based Induction Chemotherapy for Nonorgan Confined Bladder Cancer—A Reasonable Alternative for Cisplatin Unfit Patients?Journal of Urology, VOL. 188, NO. 4, (1108-1114), Online publication date: 1-Oct-2012.Eswara J, Efstathiou J, Heney N, Paly J, Kaufman D, McDougal W, McGovern F and Shipley W (2011) Complications and Long-Term Results of Salvage Cystectomy After Failed Bladder Sparing Therapy for Muscle Invasive Bladder CancerJournal of Urology, VOL. 187, NO. 2, (463-468), Online publication date: 1-Feb-2012.David K, Milowsky M, Ritchey J, Carroll P and Nanus D (2007) Low Incidence of Perioperative Chemotherapy for Stage III Bladder Cancer 1998 to 2003: A Report From the National Cancer Data BaseJournal of Urology, VOL. 178, NO. 2, (451-454), Online publication date: 1-Aug-2007.ROSENBERG J, CARROLL P and SMALL E (2018) UPDATE ON CHEMOTHERAPY FOR ADVANCED BLADDER CANCERJournal of Urology, VOL. 174, NO. 1, (14-20), Online publication date: 1-Jul-2005.WINQUIST E, KIRCHNER T, SEGAL R, CHIN J and LUKKA H (2018) Neoadjuvant Chemotherapy for Transitional Cell Carcinoma of the Bladder: A Systematic Review and Meta-AnalysisJournal of Urology, VOL. 171, NO. 2, (561-569), Online publication date: 1-Feb-2004.KIM H and STEINBERG G (2018) THE CURRENT STATUS OF BLADDER PRESERVATION IN THE TREATMENT OF MUSCLE INVASIVE BLADDER CANCERJournal of Urology, VOL. 164, NO. 3 Part 1, (627-632), Online publication date: 1-Sep-2000.ENNIS R, PETRYLAK D, SINGH P, BAGIELLA E, O’TOOLE K, BENSON M and OLSSON C (2018) THE EFFECT OF CYSTECTOMY, AND PERIOPERATIVE METHOTREXATE, VINBLASTINE, DOXORUBICIN AND CISPLATIN CHEMOTHERAPY ON THE RISK AND PATTERN OF RELAPSE IN PATIENTS WITH MUSCLE INVASIVE BLADDER CANCERJournal of Urology, VOL. 163, NO. 5, (1413-1418), Online publication date: 1-May-2000.Raghavan D (2018) EDITORIAL: BLADDER PRESERVATION IN PATIENTS WITH BLADDER CANCER-QUALITY VERSUS QUANTITY OF LIFE?Journal of Urology, VOL. 160, NO. 5, (1678-1679), Online publication date: 1-Nov-1998.SERRETTA V, LO GRECO G, PAVONE C and PAVONE-MACALUSO M (2018) THE FATE OF PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER TREATED CONSERVATIVELY WITH NEOADJUVANT CHEMOTHERAPY, EXTENSIVE TRANSURETHRAL RESECTION AND RADIOTHERAPY: 10-YEAR EXPERIENCEJournal of Urology, VOL. 159, NO. 4, (1187-1191), Online publication date: 1-Apr-1998.Ghoneim M, El-Mekresh M, El-Baz M, El-Attar I and Ashamallah A (2018) Radical Cystectomy for Carcinoma of the Bladder: Critical Evaluation of the Results in 1,026 CasesJournal of Urology, VOL. 158, NO. 2, (393-399), Online publication date: 1-Aug-1997.Holmang S, Hedelin H, Anderstrom C and Johansson S (2018) Long-Term Followup of all Patients with Muscle Invasive (Stages T2, T3 and T4) Bladder Carcinoma in a Geographical RegionJournal of Urology, VOL. 158, NO. 2, (389-392), Online publication date: 1-Aug-1997. Volume 155Issue 6June 1996Page: 1903-1906 Advertisement Copyright & Permissions© 1996 by American Urological Association, Inc.Metrics Author Information Per-Uno Malmstrom More articles by this author Erkki Rintala More articles by this author Rolf Wahlqvist More articles by this author Pekka Hellstrom More articles by this author Sverker Hellsten More articles by this author Einar Hannisdal More articles by this author Expand All Advertisement PDF downloadLoading ...