Long-term effects of conservation therapy for muscle invasive bladder carcinoma
Bibliographic record
Abstract
4519 Background: A review of outcomes of radiotherapy-based bladder conserving therapy in patients with muscle invasive bladder cancer was performed to assess the long term outcomes. Methods: Of 131 patients with T2/T3aN0M0 (TNM 1992) transitional carcinoma of the bladder managed at Princess Margaret Hospital between 1986 and 1997, 108 were treated with radiotherapy alone, 20 with radiotherapy plus concurrent cisplatin and 3 with neoadjuvant chemotherapy plus radiotherapy. Response was assessed with cystoscopy 6 weeks after completion of treatment. Salvage cystectomy was offered as appropriate to patients who failed to achieve CR or relapsed locally (32% were considered unfit for surgery). Results: Overall CR rate was 72.5%. Overall survival (OS), cause specific survival (CSS) and local relapse free rates (LRFR) at 5 years were 44%, 58% and 49% respectively. For 95 patients that achieved CR, LRFR at 5 and 10 years was 59% at median follow up of 4.8 years (0.7–15.7). Of 47 patients with recurrent disease, 31 relapsed in the bladder only, 3 in bladder and pelvis, 2 in bladder and metastases, and 10 with metastases only. Salvage treatment for those with bladder only relapse (n=31) consisted of TUR/intravesical BCG in 52% (n=16) and cystectomy in 31% (n=11). Cumulative relapse rate was 42% at 3 years and 53% at 5 years; only 1 patient relapsed after 5 years. Those unfit for surgery had lower OS (p<0.01) and CSS (p=0.04). Prognostic factors for improved CSS and LRFR included absence of CIS, small primary tumor (≤2cm); patients who received chemotherapy had improved CSS. Only 19 of 131 pts had cystectomy for failure of local control. Conclusions: RT based treatment of locally advanced bladder cancer results in bladder preservation in the majority of patients with T2-T3a N0M0 (TNM 1992) bladder cancer. For patients who achieve CR, relapse beyond 5 years is uncommon. For select patients bladder conservation therapy with multimodality approach is an alternative to radical cystectomy. No significant financial relationships to disclose.
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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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| 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".