Does delaying cystectomy for an attempt at Radiofrequency-Induced Thermochemotherapy treatment following BCG failure result in significant disease progression?
BAUS ePoster online library. Harrison J. 06/22/21; 319004; p10-15
Disclosure(s): N/A
Ms. Jade Harrison
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Introduction:
NICE guidelines recommend cystectomy or further intravesical treatments, such as Radiofrequency-Induced Thermochemotherapy (RITE), for high-risk non-muscle invasive bladder cancer (HRNMIBC) patients who fail bacillus Calmette-Guerin (BCG). What is the risk of disease progression during RITE, and can any subsequent recurrence be effectively treated with cystectomy?
Methods:
Prospective database of BCG failure patients who received RITE with mitomycin-C or epirubicin between 2007-2020 was reviewed. Electronic patient records confirmed outcomes. Development of muscle invasion, prostatic stroma infiltration or metastasis defined disease progression.
Results:
206 patients who had failed BCG received ≥5 RITE sessions. 83% were male (n=171) with median age 75 years (IQR 68-81). 67% (n=138) had carcinoma in situ +/- papillary disease. Median follow-up was 36 months (IQR 18-60).
Complete response rate at 3 months was 93% (n=192). 2 of the 14 patients that recurred during induction, developed disease progression. The remaining 12 had persistent HRNMIBC, of whom 7 underwent cystectomy.
Following complete response, 96 patients (50%) had disease recurrence or progression, 43 patients (22%) within 12 months. 41 patients underwent cystectomy for recurrence; histology confirmed disease progression in 16 patients. 62 patients with recurrence were not fit, or declined cystectomy; 27 of them subsequently progressed. 90 patients (43.6%) never recurred or progressed.
Conclusion:
RITE resulted in sustained disease-free survival in >40% of BCG failures. The risk of disease progression during induction is low. Salvage cystectomies were performed in 23%; two-thirds had no progression. Progression eventually occurs in 1-in-5 patients, however >60% of these patients were never candidates for cystectomy.
NICE guidelines recommend cystectomy or further intravesical treatments, such as Radiofrequency-Induced Thermochemotherapy (RITE), for high-risk non-muscle invasive bladder cancer (HRNMIBC) patients who fail bacillus Calmette-Guerin (BCG). What is the risk of disease progression during RITE, and can any subsequent recurrence be effectively treated with cystectomy?
Methods:
Prospective database of BCG failure patients who received RITE with mitomycin-C or epirubicin between 2007-2020 was reviewed. Electronic patient records confirmed outcomes. Development of muscle invasion, prostatic stroma infiltration or metastasis defined disease progression.
Results:
206 patients who had failed BCG received ≥5 RITE sessions. 83% were male (n=171) with median age 75 years (IQR 68-81). 67% (n=138) had carcinoma in situ +/- papillary disease. Median follow-up was 36 months (IQR 18-60).
Complete response rate at 3 months was 93% (n=192). 2 of the 14 patients that recurred during induction, developed disease progression. The remaining 12 had persistent HRNMIBC, of whom 7 underwent cystectomy.
Following complete response, 96 patients (50%) had disease recurrence or progression, 43 patients (22%) within 12 months. 41 patients underwent cystectomy for recurrence; histology confirmed disease progression in 16 patients. 62 patients with recurrence were not fit, or declined cystectomy; 27 of them subsequently progressed. 90 patients (43.6%) never recurred or progressed.
Conclusion:
RITE resulted in sustained disease-free survival in >40% of BCG failures. The risk of disease progression during induction is low. Salvage cystectomies were performed in 23%; two-thirds had no progression. Progression eventually occurs in 1-in-5 patients, however >60% of these patients were never candidates for cystectomy.
Introduction:
NICE guidelines recommend cystectomy or further intravesical treatments, such as Radiofrequency-Induced Thermochemotherapy (RITE), for high-risk non-muscle invasive bladder cancer (HRNMIBC) patients who fail bacillus Calmette-Guerin (BCG). What is the risk of disease progression during RITE, and can any subsequent recurrence be effectively treated with cystectomy?
Methods:
Prospective database of BCG failure patients who received RITE with mitomycin-C or epirubicin between 2007-2020 was reviewed. Electronic patient records confirmed outcomes. Development of muscle invasion, prostatic stroma infiltration or metastasis defined disease progression.
Results:
206 patients who had failed BCG received ≥5 RITE sessions. 83% were male (n=171) with median age 75 years (IQR 68-81). 67% (n=138) had carcinoma in situ +/- papillary disease. Median follow-up was 36 months (IQR 18-60).
Complete response rate at 3 months was 93% (n=192). 2 of the 14 patients that recurred during induction, developed disease progression. The remaining 12 had persistent HRNMIBC, of whom 7 underwent cystectomy.
Following complete response, 96 patients (50%) had disease recurrence or progression, 43 patients (22%) within 12 months. 41 patients underwent cystectomy for recurrence; histology confirmed disease progression in 16 patients. 62 patients with recurrence were not fit, or declined cystectomy; 27 of them subsequently progressed. 90 patients (43.6%) never recurred or progressed.
Conclusion:
RITE resulted in sustained disease-free survival in >40% of BCG failures. The risk of disease progression during induction is low. Salvage cystectomies were performed in 23%; two-thirds had no progression. Progression eventually occurs in 1-in-5 patients, however >60% of these patients were never candidates for cystectomy.
NICE guidelines recommend cystectomy or further intravesical treatments, such as Radiofrequency-Induced Thermochemotherapy (RITE), for high-risk non-muscle invasive bladder cancer (HRNMIBC) patients who fail bacillus Calmette-Guerin (BCG). What is the risk of disease progression during RITE, and can any subsequent recurrence be effectively treated with cystectomy?
Methods:
Prospective database of BCG failure patients who received RITE with mitomycin-C or epirubicin between 2007-2020 was reviewed. Electronic patient records confirmed outcomes. Development of muscle invasion, prostatic stroma infiltration or metastasis defined disease progression.
Results:
206 patients who had failed BCG received ≥5 RITE sessions. 83% were male (n=171) with median age 75 years (IQR 68-81). 67% (n=138) had carcinoma in situ +/- papillary disease. Median follow-up was 36 months (IQR 18-60).
Complete response rate at 3 months was 93% (n=192). 2 of the 14 patients that recurred during induction, developed disease progression. The remaining 12 had persistent HRNMIBC, of whom 7 underwent cystectomy.
Following complete response, 96 patients (50%) had disease recurrence or progression, 43 patients (22%) within 12 months. 41 patients underwent cystectomy for recurrence; histology confirmed disease progression in 16 patients. 62 patients with recurrence were not fit, or declined cystectomy; 27 of them subsequently progressed. 90 patients (43.6%) never recurred or progressed.
Conclusion:
RITE resulted in sustained disease-free survival in >40% of BCG failures. The risk of disease progression during induction is low. Salvage cystectomies were performed in 23%; two-thirds had no progression. Progression eventually occurs in 1-in-5 patients, however >60% of these patients were never candidates for cystectomy.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}