Treatment of muscle-invasive bladder cancer

A systematic review

Roger Chou, Shelley Selph, David Buckley, Kate (Katie) Gustafson, Jessica C. Griffin, Sara E. Grusing, John L. Gore

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.

Original languageEnglish (US)
Pages (from-to)842-851
Number of pages10
JournalCancer
Volume122
Issue number6
DOIs
StatePublished - Mar 15 2016

Fingerprint

Cystectomy
Urinary Bladder Neoplasms
Lymph Node Excision
Muscles
Urinary Bladder
Survival
Mortality
Therapeutics
Adjuvant Chemotherapy
Combination Drug Therapy
MEDLINE
Cisplatin
Uncertainty
Dissection
Databases
Recurrence
Drug Therapy

Keywords

  • adjuvant chemotherapy
  • bladder cancer
  • bladder-sparing therapy
  • lymph node dissection
  • neoadjuvant chemotherapy
  • radical cystectomy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Treatment of muscle-invasive bladder cancer : A systematic review. / Chou, Roger; Selph, Shelley; Buckley, David; Gustafson, Kate (Katie); Griffin, Jessica C.; Grusing, Sara E.; Gore, John L.

In: Cancer, Vol. 122, No. 6, 15.03.2016, p. 842-851.

Research output: Contribution to journalArticle

Chou, Roger ; Selph, Shelley ; Buckley, David ; Gustafson, Kate (Katie) ; Griffin, Jessica C. ; Grusing, Sara E. ; Gore, John L. / Treatment of muscle-invasive bladder cancer : A systematic review. In: Cancer. 2016 ; Vol. 122, No. 6. pp. 842-851.
@article{06b09ae76414453b8d581eda6eb9ef7c,
title = "Treatment of muscle-invasive bladder cancer: A systematic review",
abstract = "There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.",
keywords = "adjuvant chemotherapy, bladder cancer, bladder-sparing therapy, lymph node dissection, neoadjuvant chemotherapy, radical cystectomy",
author = "Roger Chou and Shelley Selph and David Buckley and Gustafson, {Kate (Katie)} and Griffin, {Jessica C.} and Grusing, {Sara E.} and Gore, {John L.}",
year = "2016",
month = "3",
day = "15",
doi = "10.1002/cncr.29843",
language = "English (US)",
volume = "122",
pages = "842--851",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "6",

}

TY - JOUR

T1 - Treatment of muscle-invasive bladder cancer

T2 - A systematic review

AU - Chou, Roger

AU - Selph, Shelley

AU - Buckley, David

AU - Gustafson, Kate (Katie)

AU - Griffin, Jessica C.

AU - Grusing, Sara E.

AU - Gore, John L.

PY - 2016/3/15

Y1 - 2016/3/15

N2 - There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.

AB - There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.

KW - adjuvant chemotherapy

KW - bladder cancer

KW - bladder-sparing therapy

KW - lymph node dissection

KW - neoadjuvant chemotherapy

KW - radical cystectomy

UR - http://www.scopus.com/inward/record.url?scp=84960329940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960329940&partnerID=8YFLogxK

U2 - 10.1002/cncr.29843

DO - 10.1002/cncr.29843

M3 - Article

VL - 122

SP - 842

EP - 851

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 6

ER -