Continuous chemoradiation following complete response to neo-adjuvant chemotherapy provides improved outcomes in muscle invasive urothelial carcinoma
Bibliographic record
Abstract
Purpose: To evaluate the outcomes of patients with localized muscle invasive bladder cancer (MIBC) treated with neo-adjuvant chemotherapy followed by continuous chemo-radiation (cCRT). To evaluate the prognostic significance of clinical complete response to neo-adjuvant chemotherapy in the setting of bladder preservation. Materials/Methods: From 2002 to 2012, twenty-two patients with cT2-4 N0-2 M0 MIBC were treated using cCRT for bladder preservation. All patients were felt to be medically inoperable and/or refused cystectomy. They were treated with maximal transurethral tumor resection (TURBT) and multiple cycles of platinum-doublet-based neoadjuvant chemotherapy, followed by definitive cCRT. Tumor response was evaluated with an abdomino-pelvic CT scan and cystoscopy 4 weeks after neoadjuvant chemotherapy and 3 months after completion of all therapy. Radiation therapy was delivered using 3DCRT or IMRT to a median dose of 45 Gy to the pelvis and 63 Gy to the bladder (range 41.4 Gy to 71.4 Gy). Three-year local control (LC) and disease-free survival (DFS) estimates were determined by the Kaplan-Meier method and log rank analysis. Results: The median age was 67.5 years. Median follow-up was 24 months (range 6 to 86). Clinical stage was T2 in 12 patients, T3 in 8, and T4 in 2. Fourteen patients were node-negative while 8 were node-positive. Actuarial 3-year OS, DFS, LC for the entire cohort were 62.2%, 62% and 78.3%, respectively. Furthermore, the 3-year OS and DFS for patients achieving a CR on cystoscopy following neo-adjuvant chemotherapy was 64.6% vs . 57.1% without CR ( p =.046), and 64.3% vs . 57.1% without CR ( p =.03). The 3-year LC was 90.9% in patients showing complete response to neo-adjuvant chemotherapy. When stratified by T stage, 3-year LC was 90.9% for T2, 87.5% for T3 and 0% for T4 ( p =.007). Local failure was associated with distant metastases in 4 out of 5 patients. Two patients had non-invasive local recurrences and both were successfully treated with intra-vesical BCG. Conclusions: Maximal TURBT followed by neo-adjuvant platinum based chemotherapy and definitive cCRT offers good rates of OS, DFS and LC in MIBC at three-years of follow-up. Complete response to neo-adjuvant chemotherapy is a favorable prognostic factor, achieving LC rates >90% at 3 years.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".