S1011 Standard or Extended Pelvic Lymphadenectomy in Treating Patients Undergoing Surgery for Invasive Bladder Cancer

Study Overview
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Brief Summary
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RATIONALE: Lymphadenectomy may remove tumor cells that have spread to nearby lymph nodes in patients with invasive bladder cancer. It is not yet known whether extended pelvic lymphadenectomy is more effective than standard pelvic lymphadenectomy during surgery. PURPOSE: This randomized phase II trial is studying standard pelvic lymphadenectomy to see how well it works compared to extended pelvic lymphadenectomy in treating patients undergoing surgery for invasive bladder cancer.

Detailed Description
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OBJECTIVES: Primary To compare disease-free survival (DFS) of patients with muscle-invasive urothelial carcinoma of the bladder undergoing radical cystectomy with extended pelvic lymph node dissection (PLND) or standard pelvic lymphadenectomy. Secondary To compare overall survival (OS) of patients randomized to extended PLND versus those randomized to standard pelvic lymphadenectomy. To evaluate operative time; whether or not nerve sparing was performed, intraoperative, peri-operative and 90-day morbidity and mortality; length of hospital stay; histology (pure urothelial versus mixed); lymph node counts and lymph node density; adjuvant chemotherapy received; and local and retroperitoneal soft tissue recurrence in patients randomized to extended PLND versus those randomized to standard pelvic lymphadenectomy. To collect peripheral blood and two paraffin-embedded blocks of the primary tumor for translational medicine studies, including circulating tumor cells (CTCs) and markers of epithelial and mesenchymal transition, and correlate these findings with pathologic T stage and node metastasis as well as DFS and OS. OUTLINE: This is a multicenter study. Patients are stratified according to prior neoadjuvant therapy (yes vs no), clinical stage (T2 vs T3 vs T4a), and Zubrod performance status (0-1 vs 2). Patients are randomized to 1 of 2 treatment arms. Arm I: Patients undergo radical cystectomy and standard pelvic lymphadenectomy. Arm II: Patients undergo radical cystectomy and extended pelvic lymphadenectomy. Blood and tumor specimens may be collected periodically for translational studies. After completion of study therapy, patients are followed up periodically for 6 years.

Official Title
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A Phase III Surgical Trial to Evaluate the Benefit of a Standard Versus an Extended Pelvic Lymphadenectomy Performed at Time of Radical Cystectomy for Muscle Invasive Urothelial Cancer

Conditions
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Bladder Cancer

Intervention / Treatment
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* Procedure: therapeutic conventional surgery
* Procedure: therapeutic standard lymphadenectomy
* Procedure: therapeutic extended lymphadenectomy


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed urothelial carcinoma of the bladder Stage T2, T3, or T4a disease No clinical stage consistent with a low-risk of node metastasis (CIS only, T1) No T4b disease (fixed lesion) Disease that requires primary radical cystectomy and lymph node dissection for definitive treatment No laparoscopic surgery Predominant urothelial carcinoma with any of the following elements allowed: Adenocarcinoma Squamous cell carcinoma Micropapillary or minor components of other rare phenotype No pure squamous cell carcinoma or adenocarcinoma No visceral or nodal metastatic disease proximal to the common iliac bifurcation by 2-view chest x-ray and abdominal-pelvic imaging by computerized tomography or MRI of the abdomen and pelvis No intra-operative pelvic lymph node involvement (confirmed by frozen section) at or above the bifurcation of the common iliac vessels in any of the extended template PATIENT CHARACTERISTICS: Zubrod performance status 0-2 ALT and AST ≤ upper limit of normal (ULN)* Alkaline phosphatase ≤ ULN* Not pregnant or nursing Fertile patients must use an effective contraception No other prior malignancy except adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or stage I or II cancer from which the patient is in complete remission for the past 5 years Medically suitable to undergo cystectomy, in the physician's opinion NOTE: *Levels may be ≥ ULN provided metastatic disease is excluded using dedicated liver imaging, bone scan, or biopsy. PRIOR CONCURRENT THERAPY: See Disease Characteristics No prior partial cystectomy for invasive bladder cancer No prior pelvic surgery that would obviate a complete extended lymphadenectomy (e.g., aorto-femoral/iliac bypass) Prior neoadjuvant chemotherapy for this cancer allowed provided it has been completed and patient has recovered No prior pelvic irradiation

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 120 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Arm I<br>therapeutic conventional surgery therapeutic standard lymphadenectomy | Procedure: therapeutic conventional surgery<br>* Patients undergo radical cystectomy<br>Procedure: therapeutic standard lymphadenectomy<br>* Patients undergo standard pelvic lymphadenectomy.<br>|
| Experimental: Arm II<br>therapeutic conventional surgery therapeutic extended lymphadenectomy | Procedure: therapeutic conventional surgery<br>* Patients undergo radical cystectomy<br>Procedure: therapeutic extended lymphadenectomy<br>* Patients undergo extended pelvic lymphadenectomy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Disease-free survival |  | Up to 6 years from date of Step 2 Registration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival |  | Up to 6 years from date of Step 2 Registration | 
| Morbidity |  | Up to 6 years from date of Step 2 Registration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stage II bladder cancer, stage III bladder cancer, transitional cell carcinoma of the bladder