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Titolo:
Integrated therapy for locally advanced bladder cancer: Final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC
Autore:
Millikan, R; Dinney, C; Swanson, D; Sweeney, P; Ro, JY; Smith, TL; Williams, D; Logothetis, C;
Indirizzi:
Univ Texas, MD Anderson Canc Ctr, Ctr Genitourinary Oncol, Houston, TX 77030 USA Univ Texas Houston TX USA 77030 enitourinary Oncol, Houston, TX 77030 USA
Titolo Testata:
JOURNAL OF CLINICAL ONCOLOGY
fascicolo: 20, volume: 19, anno: 2001,
pagine: 4005 - 4013
SICI:
0732-183X(20011015)19:20<4005:ITFLAB>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANSITIONAL-CELL-CARCINOMA; LYMPH-NODE DISSECTION; RADICAL CYSTECTOMY; PERIOPERATIVE CHEMOTHERAPY; CISPLATIN; METHOTREXATE; VINBLASTINE; DOXORUBICIN; SURVIVAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
18
Recensione:
Indirizzi per estratti:
Indirizzo: Millikan, R Univ Texas, MD Anderson Canc Ctr, Ctr Genitourinary Oncol, Box013,1515 Holcombe Blvd, Houston, TX 77030 USA Univ Texas Box 013,1515 Holcombe Blvd Houston TX USA 77030 USA
Citazione:
R. Millikan et al., "Integrated therapy for locally advanced bladder cancer: Final report of a randomized trial of cystectomy plus adjuvant M-VAC versus cystectomy with both preoperative and postoperative M-VAC", J CL ONCOL, 19(20), 2001, pp. 4005-4013

Abstract

Purpose: We conducted a phase III trial to investigate the timing of chemotherapy with respect to surgery for patients with resectable but high-risk urothelial cancer. The trial was also designed to evaluate the accuracy of clinical staging in patients with locally advanced cancer and the prognostic significance of chemotherapy-induced downstaging. Patients and Methods: A total of 140 uniformly evaluated patients with locally advanced urothelial cancer were studied. Planned treatment was five cycles of chemotherapy (M-VAC: methotrexate, vinblastine, doxorubicin, and cisplatin) plus radical cystectomy and pelvic lymph node dissection. Patientswere randomly assigned to receive either two courses of neoadjuvant M-VAC followed by surgery plus three additional cycles of chemotherapy, or, alternatively, to have initial cystectomy followed by five cycles of adjuvant chemotherapy. Results: There were no significant differences in outcome between the two groups. By intent-to-treat, 81 patients (58%) remain disease-free, with median follow-up of 6.8 years. We confirmed a high rate of clinical understaging in this cohort, especially among patients showing lymphovascular invasion on biopsy. Patients with no residual muscle-invasive disease at cystectomy after neoadjuvant chemotherapy were likely to be cured. Conclusion: These results lend further support to the impression from small randomized trials that, in a high-risk cohort, there is an improved cure fraction by the combination of multiagent chemotherapy and surgery, although we found no preferred sequence. Importantly, it is possible to select appropriate patients for such therapy on the basis of clinical staging information. These results establish a benchmark of outcome for this cohort.

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Documento generato il 10/07/20 alle ore 15:53:08