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Saravanabavan S, Prakash GJ, Joshi A, Pal M, Gujela A, Arora A, Bakshi G, Prabhash K, Noronha V, Murthy V, Maitre P, Teja R. Patterns of Utilization and Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced-urothelial Bladder Cancer (LABC)-Real World Data From an Indian Tertiary Care Cancer Center. Clin Genitourin Cancer 2023; 21:e326-e333. [PMID: 37211451 DOI: 10.1016/j.clgc.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 05/23/2023]
Abstract
AIM Optimal utilization of perioperative systemic therapy in locally advanced bladder cancer (LABC) holds the key in improving the survival outcomes. We aim to analyze the oncological outcomes of clinically locally advanced urothelial bladder cancer patients treated with neoadjuvant (NACT) or adjuvant chemotherapy or without any systemic therapy in the perioperative period of radical cystectomy. METHODS & MATERIAL We retrospectively analyzed the medical records of patients with cancer of the urinary bladder diagnosed between 2012 and 2020. The demographic profile, and the treatment received, was recorded for all patients. Oncological outcomes of the patients based on these variables were analyzed. RESULTS Two hundred and twenty nine (229) locally advanced bladder cancer patients were included in the study. Eighty eight (38%) of them underwent upfront radical cystectomy and 141 (62%) received neoadjuvant chemotherapy (NACT). With a median follow-up of 27 months, the 2-year DFS in either of the groups was 65.4% and 67.1% respectively (P - 0.373). In the multivariate analysis, the pathological lymph nodal status and lymph vascular invasion (LVI) status influenced the DFS. The initial modality of management chosen did not affect the outcome. (HR - 0.688; 95% CI: 0.38-1.21). The commonest reason for not receiving NACT was Cisplatin ineligibility due to malignant obstructive uropathy and a subgroup analysis of this set of patients also did not show any significant difference in 2 year DFS compared to those who received NACT. CONCLUSION A significant proportion of patients with LABC are unable to receive the recommended neoadjuvant chemotherapy and obstructive uropathy is the commonest reason for this in our centre. In our single centre series upfront radical cystectomy followed by adjuvant platinum based therapy had an outcome similar to neoadjuvant chemotherapy in LABC patients, in patients who were unable to receive the same due to various reasons.
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Affiliation(s)
- Srivishnu Saravanabavan
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Gagan J Prakash
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001.
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001. https://twitter.com/https://twitter.com/drgaganprakash
| | - Mahendra Pal
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ajit Gujela
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Amandeep Arora
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ganesh Bakshi
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
| | - Ravi Teja
- Division of Uro Oncology , Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India, 40001
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Prakash G, Chandankhede U, Nadkarni S, Pal M, Arora A, Gujela A, Bakshi G. The Belly-Up technique for pericaval nodal dissection in RPLND - Saving caval resections and reconstructions. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Sharma AK, Sharma S, Swain S, Goel G, Gujela A, Hota D, Mohapatra B, Sharma B. A comparative study of air pyelogram and contrast pyelogram for initial puncture access and to see its efficacy during percutaneous nephrolithotomy. Urol Ann 2022; 14:340-344. [PMID: 36505991 PMCID: PMC9731196 DOI: 10.4103/ua.ua_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Objective The current investigation was aimed to compare the safety, efficacy, adverse effects, and outcome of air pyelogram versus contrast pyelogram for percutaneous nephrolithotomy. Materials and Methods This was a cross-sectional study conducted from August 2018 to November 2020, which included 400 patients with a clinical diagnosis of renal calculus and randomly (1:1) assigned into Group I (air pyelogram) and Group II (contrast pyelogram). Air was injected in Group I and diatrizoate meglumine 76% was used in Group II for PCS identification. In the case of difficulty in visualization in either group, a mixture of contrast and air was used. The following parameters were assessed: duration of access, total duration of radiation exposure during access, total attempts needed to puncture the desired calyx, failure rate, complications, and outcomes. Results Both the groups were comparable including renal calculus characteristics. The mean (standard deviation) duration of access was 3.08 (1.21) and 5.23 (1.02) min (P < 0.0001) in Groups I and II, respectively; in 85% and 57.5% of patients (P < 0.0001), respectively, the caliceal puncture was done in a single attempt. The duration of radiation exposure was more in Group II (P < 0.0001). The failure rate (22%) was higher and statistically significant in Group II. The stone clearance rate was not statistically significant between the groups (P = 0.380). No patient had hypoxia, cardiopulmonary complications, and air embolism in perioperative period. Conclusion Air contrast is effective and safe, and it reduces the duration of caliceal puncture and radiation exposure with lower failure rate. If both air and contrast fail, a combination of both may be effective.
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Affiliation(s)
- Amit Kumar Sharma
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Shweta Sharma
- Department of Microbiology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Samir Swain
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India,Address for correspondence: Dr. Samir Swain, Department of Urology, SCB Medical College and Hospital, Cuttack - 753 007, Odisha, India. E-mail:
| | - Gourab Goel
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Ajit Gujela
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Datteswar Hota
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Biswajit Mohapatra
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India
| | - Bhoopendra Sharma
- Department of Urology, SCB Medical College and Hospital, Cuttack, Odisha, India
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