A Proposed Tetra-modal Treatment Protocol for Muscle Invasive Urothelial Carcinoma of the Urinary Bladder

Study Overview
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Brief Summary
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In Egypt, bladder cancer has been the most common cancer during the past 50 years. In 2002, Egypt's world-standardized bladder cancer incidence was 37/ 100,000, representing approximately 30,000 new cases each year. About 25% of new diagnoses are muscle-invasive bladder cancer (MIBC), which carry a worse prognosis compared to non-muscle invasive disease. Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) with bilateral pelvic lymphadenectomy is considered the standard of care for treatment of MIBC by multiple international guidelines. However, this is associated with a significant impact on quality of life. The effect of our proposed Tetra-modal treatment protocol for muscle invasive Urothelial carcinoma of the urinary bladder on muscle invasive bladder cancer recurrence free survival, cancer specific survival, and overall survival? Koga developed a selective bladder-sparing protocol with a tetra modal therapy comprising maximal transurethral resection of bladder tumor, induction chemoradiation (CRT), and consolidative partial cystectomy (PC) with pelvic lymph node dissection, allowing the confirmation of CRT response pathologically. In the preliminary analysis of the initial cases enrolled in their protocol, none of the patients who completed the protocol with consolidative PC experienced MIBC recurrence, suggesting that consolidative PC may improve local cancer control in the preserved bladder by surgically eliminating possible cancer remnants after CRT. Our proposed Tetra-modal treatment protocol for MIBC is supposed to eliminate the surgical difficulties of performing PC in a radiated field and hence decrease the post operative complications of PC.

Official Title
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A Proposed Tetra-modal Treatment Protocol for Muscle Invasive Urothelial Carcinoma of the Urinary Bladder

Conditions
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Bladder Cancer

Intervention / Treatment
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* Procedure: terta modal bladder preservation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Tumor size ≤ 50 % of bladder surface or multiple tumors in an area of the bladder that is ≤ 50 % of total bladder surface. Tumor at least 2 cm away from bladder neck or trigone. Clinically, no residual disease or minimal amounts of non-invasive disease in the original MIBC site after NAC at restaging TURBT (if done). Pathologically confirmed urothelial carcinoma. Exclusion Criteria: Prescence of CIS. Presence of distant metastasis. Patients unfit for cisplatin-based chemotherapy.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 90 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| tetra modal bladder preservation<br> | Procedure: terta modal bladder preservation<br>* neoadjuvant chemotherapy, partial cystectomy, radiotherapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| local recurrence rate | the patient will be evaluated using MRI and cystoscopy | the patient will be evaluted after partial cystectomy every 3 months for 2 years | 
| over active bladder symptom score | the patient will be asked about his symptoms using a questionnaire that is concerned about urgency , frequency , urge incontinence . | this questionnaire will be carried every 6 month for at least 2 years after the partial cystectomy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Tetramodal bladder preservation, urothelial carcinoma, partial cystectomy