Concurrent cisplatin and radiotherapy: Decision making, tolerability, and outcomes for patients treated in a multidisciplinary bladder clinic.
Bibliographic record
Abstract
320 Background: For select muscle invasive bladder cancer (MIBC) patients, a multimodal approach using transurethral resection of the bladder tumor (TURBT) followed by concurrent cisplatin and external beam radiotherapy (EBRT) provides a curative bladder-sparing alternative to cystectomy. Our aim was to review decision making, tolerability and outcomes for patients treated in a multidisciplinary bladder clinic. Methods: Between June 1998-June 2011, MIBC patients treated with TURBT and concurrent cisplatin (40mg/m2 weekly) with EBRT (60-66Gy in 30-33 fractions to the bladder and pelvis) were identified. Post-treatment cystoscopy was performed every 3 months with regular imaging. Results: A total of 64 patients were assessed; mean age 73 (43-89), 83% were male. The decision to attempt bladder-sparing was based on patient preference (58%), nonsurgical candidate (25%), or unknown (17%). Patients received a mean 5/6 weeks of cisplatin with the most common toxicity being a 14% overall risk of grade 0-1 renal toxicity by NCIC CTC criteria. All patients completed the prescribed EBRT. No patients experienced acute toxicity requiring cystectomy or causing death. At a median follow-up of 3.5 years, 50/64 (78%) patients were alive and had their own bladders, 7/64 (11%) were alive after cystectomy for recurrence, 7/64 (11%) died. Of the 24/64 (38%) recurrences: 3/64 (5%) had positive cytology/carcinoma in-situ and received intravesicle therapy; 1/64 (2%) had local superficial recurrence and underwent TURBT; 7/64 (11%) had local invasive recurrence requiring cystectomy; 13/64 (20%) had distant recurrence, 6 received chemotherapy and 7 were observed. Estimated disease free survival was 51%, and overall survival was 90% at 3.5 years. Conclusions: Bladder-sparing therapy with concurrent cisplatin and EBRT is a well-tolerated and effective approach with outcomes comparable to cystectomy in carefully selected patients. Prospective trials are required to delineate clinical and molecular factors to further triage patients into sub-groups who may benefit from bladder sparing with neoadjuvant/adjuvant chemotherapy or molecularly-targeted agents to improve survival.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 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".