For selected patients with muscle-invasive bladder cancer (MIBC), trimodal therapy (TMT) incorporating transurethral resection of the tumor and chemoradiotherapy is an alternative to radical cystectomy. Concurrent chemotherapy (CC) is a pivotal component of TMT, however, the optimal CC protocol remains unknown. This systematic review aims to assess efficacy and safety outcomes of CC protocols used in TMT.
A systematic literature search in the PubMed and Embase databases was performed to identify eligible studies published between 1980 and March 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data extraction and risk of bias assessment were performed following predefined criteria.
50 studies met the inclusion criteria. Cisplatin-based CC protocols were the most reported. The highest level of evidence was found for 5-fluorouracil and Mitomycin C and for Carbogen-Nicotinamide. However, significant heterogeneity in patient selection, treatment modalities, follow-up and reported outcomes precluded comparison between trials. Outcomes were similar regardless of CC, with 5-year overall survival around 50%. Bladder preservation rates ranged from 60% to 90%. Distant metastasis rates varied from 10% to 45%. Locoregional control rates seemed improved with cisplatin combinations despite an increased acute toxicity. Acute and late toxicity were however relatively low across CC protocols. There was no decrease in gastro-intestinal or urinary Quality of Life. Scarce data were available for elderly patients.
With similar efficacy and toxicity profiles, and in the absence of comparability among trials, our review does not provide sufficient data to determine the optimal CC for TMT of MIBC. TMT is a well-tolerated and efficient approach with tailored strategy available for patients with localized MIBC.
Critical reviews in oncology/hematology. 2024 Nov 21 [Epub ahead of print]
Camille Baudelin, Paul Sargos, Derek Dinart, Christophe Hennequin, Diego Teyssonneau, Lucie Meynard, Nam-Son Vuong, Félix Lefort, Michael Baboudjian, Guilhem Roubaud
Department of Medical Oncology, Institut Bergonié, Bordeaux, France; Department of Radiation Oncology, Institut Bergonié, Bordeaux, France, Amethyst Radiotherapy Group, La Garenne Colombes, France. Electronic address: ., Clinical Research and Clinical Epidemiology Unit, Institut Bergonié, Bordeaux, France. Electronic address: ., Department of Radiation Oncology, Hôpital Saint-Louis, Paris, France. Electronic address: ., Department of Medical Oncology, Institut Bergonié, Bordeaux, France. Electronic address: ., Department of Medical Oncology, Institut Bergonié, Bordeaux, France. Electronic address: ., Department of Urology, Clinique Saint-Augustin, Bordeaux, France. Electronic address: ., Department of Medical Oncology, University Hospital, Bordeaux, France. Electronic address: ., Department of Urology, APHM, North Academic Hospital, Marseille, France. Electronic address: ., Department of Medical Oncology, Institut Bergonié, Bordeaux, France. Electronic address: ., Department of Medical Oncology, Institut Bergonié, Bordeaux, France. Electronic address: .