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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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) | 0.000 | 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 teacher head, 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".