Long-term outcomes of neoadjuvant chemotherapy (NAC) before bladder-sparing chemoradiotherapy (CRT) for patients with nonmetastatic muscle-invasive bladder cancer (MIBC).
Bibliographic record
Abstract
819 Background: Neoadjuvant cisplatin-based combination chemotherapy followed by concurrent chemoradiation is an emerging approach in carefully selected MIBC patients who opt for bladder sparing however, long-term data on its efficacy and tolerability remains lacking. We evaluated long-term outcomes in MIBC patients treated with this approach. Methods: We conducted a retrospective chart review of patients treated with NAC followed by CRT bladder sparing approaches between 2008 and 2017 at the Princess Margaret Cancer Centre and Lakeridge Health Cancer Centers. We initially published the feasibility of this approach and early outcome data in 2018. In this analysis, we updated long-term disease free survival (DFS), bladder intact disease free survival (BI-DFS) and overall survival (OS). Results: In total 57 patients were treated with NAC + CRT. Most were male with a median age of 72 (range 45-87), and an Eastern Cooperative Oncology Group performance status of 0 (60%) or 1 (40%). Patients with stage II (65%), and stage III disease (25%), as well as regional nodal metastases (11%), carcinoma in situ (28%) and hydronephrosis (25%) were included. The majority of patients completed planned NAC (95%). All patients completed external-beam radiotherapy, and 84% completed at least 60% of the planned concurrent weekly cisplatin doses. Median follow up for this population was 74.4 months (9.7-142.1). At the time of this updated analysis, 23/57 (40%) recurred, local recurrence occurred in 11/57 patients (19%), and 9/57 patients (16%) required salvage cystectomy. Distant recurrence occurred in 12/57 (21%) patients, all of whom died as a result of bladder cancer. The median DFS for the study population was 56.7 months (95% CI 25.3-99.1), and 5-year DFS rate was 49%. The median BI-DFS was 40.1 months (95% CI 23.3-85.4) and 5-year BI-DFS rate was 45%. The median OS was 104.9 months (95% CI 60.8-119.2) with a 5-year OS rate of 65% (95% CI 50.7-75.5). Conclusions: NAC+CRT is a safe and effective approach for selected patients with MIBC with encouraging long-term outcomes. This data supports evaluating neoadjuvant and adjuvant systemic therapies along with bladder preservation strategies in prospective clinical trials.
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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 | 0.001 | 0.002 |
| 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".