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Bamias A, Stenzl A, Zagouri F, Andrikopoulou A, Hoskin P. Defining Oligometastatic Bladder Cancer: A Systematic Review. EUR UROL SUPPL 2023; 55:28-37. [PMID: 37662704 PMCID: PMC10468799 DOI: 10.1016/j.euros.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Context Unlike other cancers, the concept of oligometastatic disease (OMD) in bladder cancer (BC) has not been systematically investigated. There is therefore a need to develop universally accepted definitions and guidelines for the management of oligometastatic BC (OMBC). Objective To conduct a systematic review to assist a European consensus group in producing a definition of OMBC and to provide recommendations on staging and local therapies. Evidence acquisition The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. Abstracts for articles focused on BC that addressed the issue of OMBC and provided a definition of oligometastatic status were selected. We collected data on the number of metastases, the number of metastases per organ, the number of organs involved, and metastatic sites that were excluded. Evidence synthesis Sixteen eligible articles were retrieved (9 retrospective series involving 330 patients, 4 reviews, 1 consensus statement, 1 guideline paper, and 1 ongoing prospective phase 2 trial). A maximum of three to five metastatic lesions were compatible with the definition of OMBC. The number of organs involved and lesion size were not universally included in the OMBC definitions. OMD categories studied included synchronous OMBC, oligorecurrence, and oligoprogression. 18F-Fluorodeoxyglucose positron emission tomography combined with computed tomography was used in addition to conventional imaging for OMD detection. Surgery and radiotherapy were both used. Systemic chemotherapy was also used in all studies. Conclusions There is little information on OMBC in the literature. Our systematic review revealed that only three to five metastatic sites amenable to surgery or radiotherapy that respond to systemic therapy is the setting most frequently chosen for a combination of systemic treatment and metastases-directed therapy. This setting could represent a basis for future prospective studies on OMBC. Patient summary Oligometastatic bladder cancer is a disease state in which favorable outcomes can be expected after a treatment combination of systemic therapy, plus surgery and/or radiotherapy for sites of bladder cancer metastasis. Our systematic review showed a lack of meaningful evidence to define this disease state. There is an urgent need to develop organized research in this field.
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Affiliation(s)
- Aristotelis Bamias
- Second Propaedeutic Department of Internal Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | - Arnulf Stenzl
- Department of Urology, University Medical Centre, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Flora Zagouri
- Hellenic GU Cancer Group, Athens, Greece
- Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Angeliki Andrikopoulou
- Department of Clinical Therapeutics, National & Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| | - Peter Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Aboudaram A, Chaltiel L, Pouessel D, Graff-Cailleaud P, Benziane-Ouaritini N, Sargos P, Schick U, Créhange G, Cohen-Jonathan Moyal E, Chevreau C, Khalifa J. Consolidative Radiotherapy for Metastatic Urothelial Bladder Cancer Patients with No Progression and with No More than Five Residual Metastatic Lesions Following First-Line Systemic Therapy: A Retrospective Analysis. Cancers (Basel) 2023; 15:cancers15041161. [PMID: 36831503 PMCID: PMC9954747 DOI: 10.3390/cancers15041161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Local consolidative radiotherapy in the treatment of metastatic malignancies has shown promising results in several types of tumors. The objective of this study was to assess consolidative radiotherapy to the bladder and to residual metastases in metastatic urothelial bladder cancer with no progression following first-line systemic therapy. MATERIALS/METHODS Patients who received first-line therapy for the treatment of metastatic urothelial bladder cancer (mUBC) and who were progression-free following treatment with no more than five residual metastases were retrospectively identified through the database of four Comprehensive Cancer Centers, between January 2005 and December 2018. Among them, patients who received subsequent definitive radiotherapy (of EQD2Gy > 45Gy) to the bladder and residual metastases were included in the consolidative group (irradiated (IR) group), and the other patients were included in the observation group (NIR group). Progression-free survival (PFS) and overall survival (OS) were determined from the start of the first-line chemotherapy using the Kaplan-Meier method. To prevent immortal time bias, a Cox model with time-dependent covariates and 6-month landmark analyses were performed to examine OS and PFS. RESULTS A total of 91 patients with at least stable disease following first-line therapy and with no more than five residual metastases were analyzed: 51 in the IR group and 40 in the NIR group. Metachronous metastatic disease was more frequent in the NIR group (19% vs. 5%, p = 0.02); the median number of metastases in the IR group vs. in the NIR group was 2 (1-9) vs. 3 (1-5) (p = 0.04) at metastatic presentation, and 1 (0-5) vs. 2 (0-5) (p = 0.18) after completion of chemotherapy (residual lesions), respectively. Two grade 3 toxicities (3.9%) and no grade 4 toxicity were reported in the IR group related to radiotherapy. With a median follow up of 85.9 months (95% IC (36.7; 101.6)), median OS and PFS were 21.7 months (95% IC (17.1; 29.7)) and 11.1 months (95% IC (9.9; 14.1)) for the whole cohort, respectively. In multivariable analysis, consolidative radiotherapy conferred a benefit in both PFS (HR = 0.49, p = 0.007) and OS (HR = 0.47, p = 0.015) in the whole population; in the landmark analysis at 6 months, radiotherapy was associated with improved OS (HR = 0.48, p = 0.026), with a trend for PFS (HR = 0.57, p = 0.082). CONCLUSION Consolidative radiotherapy for mUBC patients who have not progressed after first-line therapy and with limited residual disease seems to confer both OS and PFS benefits. The role of consolidative radiotherapy in the context of avelumab maintenance should be addressed prospectively.
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Affiliation(s)
- Amélie Aboudaram
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31000 Toulouse, France
| | - Léonor Chaltiel
- Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31059 Toulouse, France
| | - Damien Pouessel
- Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31059 Toulouse, France
| | | | | | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, 33000 Bordeaux, France
| | - Ulrike Schick
- Department of Radiation Oncology, CHU Brest, 29200 Brest, France
| | - Gilles Créhange
- Department of Radiation Oncology, Institut Curie, 75248 Paris, France
| | - Elizabeth Cohen-Jonathan Moyal
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31000 Toulouse, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31059 Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse—Oncopole, 31000 Toulouse, France
- Correspondence: ; Tel.: +33-5-31-15-54-01
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Multidisciplinary Management and Radiotherapy Recommendations for Clinically and Pathologically Node-positive Bladder Cancer. Semin Radiat Oncol 2023; 33:35-50. [PMID: 36517192 DOI: 10.1016/j.semradonc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are limited data regarding the optimal management of patients with pelvic node-positive, but non-metastatic, bladder cancer. Increasing data demonstrate that this is a distinct clinical entity with outcomes bridging between bladder-confined muscle-invasive bladder cancer and metastatic advanced bladder cancer. Guidelines and staging systems have formalized the need to incorporate the unique considerations of management of pelvic node-positive bladder cancer. However, there remains an absence of a definite standard of care. Treatment options include systemic therapy alone, neoadjuvant chemotherapy followed by radical cystectomy, or bladder-preserving trimodality therapy. Furthermore, ongoing studies aim to determine the benefit of incorporating immunotherapy into these treatment paradigms. In this review article, we will discuss the key considerations for management of patients with pelvic node-positive bladder cancer.
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Longo N, Celentano G, Napolitano L, La Rocca R, Capece M, Califano G, Collà Ruvolo C, Mangiapia F, Fusco F, Morra S, Turco C, Di Bello F, Fusco GM, Cirillo L, Cacciapuoti C, Spirito L, Calogero A, Sica A, Sagnelli C, Creta M. Metastasis-Directed Radiation Therapy with Consolidative Intent for Oligometastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14102373. [PMID: 35625979 PMCID: PMC9139743 DOI: 10.3390/cancers14102373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Patients with oligometastatic urothelial carcinoma represent a challenging subset of subjects to manage. Herein we summarized evidence about the role of metastasis-directed radiation therapy in this clinical setting. Available preliminary evidence supports the role of metastasis-directed radiation therapy as a safe and efficacious option as it has the potential to facilitate local disease control and overall survival. However, in the absence of data from high-quality trials, definitive recommendations cannot be provided, and patients should be counseled on an individual basis. Abstract The management of patients with oligometastatic urothelial carcinoma (UC) represents an evolving field in uro-oncology, and the role of metastasis-directed therapies, including metastasectomy and metastasis-directed radiation therapy (MDRT), is gaining increasing attention. Herein, we summarize available evidence about the role of MDRT with consolidative intent in oligometastatic UC patients. A systematic review was performed in December 2021. Six studies involving 158 patients were identified. Most patients (n = 120, 90.2%) had a history of bladder cancer and the most frequent sites of metastases were lymph nodes (n= 61, 52.1%) followed by the lungs (n = 34, 29%). Overall, 144 metastases were treated with MDRT. Median follow-up ranged from 17.2 to 25 months. Local control rates ranged from 57% to 100%. Median Overall Survival (OS) ranged from 14.9 to 51.0 months and median progression-free survival ranged from 2.9 to 10.1 months. Rates of OS at one and two years ranged from 78.9% to 96% and from 26% to 63%, respectively. Treatment-related toxicity was recorded in few patients and in most cases a low-grade toxicity was evident. MDRT with consolidative intent represents a potential treatment option for selected patients with oligometastatic UC.
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Affiliation(s)
- Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Giuseppe Celentano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
- Correspondence: ; Tel.: +39-0817462611
| | - Roberto La Rocca
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Marco Capece
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Gianluigi Califano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Francesco Mangiapia
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Ferdinando Fusco
- Department of Woman, Child and General, Specialized Surgery, Urology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.F.); (L.S.)
| | - Simone Morra
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Carmine Turco
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Francesco Di Bello
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Giovanni Maria Fusco
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Luigi Cirillo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Crescenzo Cacciapuoti
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
| | - Lorenzo Spirito
- Department of Woman, Child and General, Specialized Surgery, Urology Unit, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.F.); (L.S.)
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Va Pansini, 5, 80131 Naples, Italy;
| | - Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie n. 1, 80138 Naples, Italy;
| | - Massimiliano Creta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (N.L.); (G.C.); (R.L.R.); (M.C.); (G.C.); (C.C.R.); (F.M.); (S.M.); (C.T.); (F.D.B.); (G.M.F.); (L.C.); (C.C.); (M.C.)
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