Treatment of muscle-invasive bladder cancer in patients without comorbidities and fit for surgery: Trimodality therapy vs radical cystectomy. Development of GRADE (Grades of Recommendation, Assessment, Development and Evaluation) recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO)

[Display omitted] •A systematic review of studies comparing TMT and RC for MIBC patients was performed.•Qualitative and quantitative evaluation of outcomes was performed with GRADE system.•A final weak positive recommendation in favour of TMT versus RC was developed. To compare trimodality therapy (...

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Published in:Critical reviews in oncology/hematology 2021-03, Vol.159, p.103235-103235, Article 103235
Main Authors: Francolini, Giulio, Borghesi, Simona, Fersino, Sergio, Magli, Alessandro, Jereczek-Fossa, Barbara Alicja, Cristinelli, Luca, Rizzo, Mimma, Corvò, Renzo, Pappagallo, Giovanni L., Arcangeli, Stefano, Magrini, Stefano Maria, D’Angelillo, Rolando M.
Format: Article
Language:English
Subjects:
Bladder cancer
Cystectomy
Humans
Italy - epidemiology
Medical Oncology
Muscle-invasive
Muscles
Neoplasm Invasiveness
Prospective Studies
Retrospective Studies
Surgery
Treatment Outcome
Trimodality therapy
Urinary Bladder Neoplasms - epidemiology
Urinary Bladder Neoplasms - therapy
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Summary:[Display omitted] •A systematic review of studies comparing TMT and RC for MIBC patients was performed.•Qualitative and quantitative evaluation of outcomes was performed with GRADE system.•A final weak positive recommendation in favour of TMT versus RC was developed. To compare trimodality therapy (TMT) versus radical cystectomy (RC) and develop GRADE (Grades of Recommendation, Assessment, Development and Evaluation) Recommendation by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) for treatment of muscle-invasive bladder cancer (MIBC). Prospective and retrospective studies comparing TMT and RC for MIBC patients were included. Qualitative and quantitative evaluation of evidence was made. Ten studies were included in the analysis. Pooled analysis showed salvage cystectomy and pathological complete response rates after TMT of 12 % and 72–77.5 %, respectively. Pooled rates of G3-G4 GU toxicity and serious toxicity rate were 18 vs 3% and 45 vs 29 % for patients undergoing TMT vs RC, respectively. The panel assessed a substantial equivalence in terms of OS and CSS at 5 years between TMT and RC. TMT could be suggested as an alternative treatment to RC in non-metastatic MIBC patients, deemed fit for surgery.
ISSN:1040-8428
1879-0461
DOI:10.1016/j.critrevonc.2021.103235