Patterns of Failure after Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy This work will be presented at the 12th annual American Society of Clinical Oncology Genitourinary Cancers Symposium, January 7-9, 2016.

Abhinav V. Reddy, Joseph J. Pariser, Shane M. Pearce, Ralph R. Weichselbaum, Norm D. Smith, Gary D. Steinberg, Stanley L. Liauw

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Abstract

Purpose In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods and Materials Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariate analysis for association with LF and overall survival. Results A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were all associated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

Original languageEnglish (US)
Pages (from-to)1031-1039
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume94
Issue number5
DOIs
StatePublished - Apr 1 2016

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Urogenital Neoplasms
bladder
Cystectomy
Urinary Bladder Neoplasms
radiation therapy
Radiotherapy
cancer
lymphatic system
Multivariate Analysis
Lymph Nodes
Recurrence
Survival
dissection
Lymph Node Excision
strata
chemotherapy
muscles

Cite this

@article{efc47b98072d49a98fec602d4f1a05ac,
title = "Patterns of Failure after Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy This work will be presented at the 12th annual American Society of Clinical Oncology Genitourinary Cancers Symposium, January 7-9, 2016.",
abstract = "Purpose In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20{\%} of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods and Materials Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariate analysis for association with LF and overall survival. Results A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46{\%} received perioperative chemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were all associated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12{\%}, 33{\%}, and 72{\%}, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34{\%} of patients with LF had local-regional only disease at the time of recurrence. Conclusions Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30{\%}. These patients may be the most likely to benefit from local adjuvant therapies.",
author = "Reddy, {Abhinav V.} and Pariser, {Joseph J.} and Pearce, {Shane M.} and Weichselbaum, {Ralph R.} and Smith, {Norm D.} and Steinberg, {Gary D.} and Liauw, {Stanley L.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.ijrobp.2015.10.051",
language = "English (US)",
volume = "94",
pages = "1031--1039",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
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TY - JOUR

T1 - Patterns of Failure after Radical Cystectomy for pT3-4 Bladder Cancer

T2 - Implications for Adjuvant Radiation Therapy This work will be presented at the 12th annual American Society of Clinical Oncology Genitourinary Cancers Symposium, January 7-9, 2016.

AU - Reddy, Abhinav V.

AU - Pariser, Joseph J.

AU - Pearce, Shane M.

AU - Weichselbaum, Ralph R.

AU - Smith, Norm D.

AU - Steinberg, Gary D.

AU - Liauw, Stanley L.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Purpose In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods and Materials Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariate analysis for association with LF and overall survival. Results A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were all associated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

AB - Purpose In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods and Materials Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariate analysis for association with LF and overall survival. Results A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were all associated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

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U2 - 10.1016/j.ijrobp.2015.10.051

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