DEBATE IN CA BLADDER TMT VS CYSTECTOMY
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DEBATE IN CA BLADDER TMT VS CYSTECTOMY
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DEBATE IN CA BLADDER TMT VS CYSTECTOMY
- 1. Dr KanhuCharanPatro MD,DNB(Radiation Oncology),MBA,FICRO,FAROI(USA),PDCR,CEPC HOD, Radiation Oncology ISRo- Institute of Stereotatctic Radiation Oncology Mahatma Gandhi Cancer Hospital & Research Institute, Visakhapatnam drkcpatro@gmail.com /M- +91-9160470564/ www.drkanhupatro.com CA.URINARY BLADDER TMT VS CYSTECTOMY
- 3. Radiation was discovered and radiation oncologists are born to make the history by reversing the history made by surgeons by preserving the organs and ultimately improving the QOL of the patients Quote of the day
- 4. ERA OF ORGAN PRESERVATION HEAD AND NECK ESOPHAGUS PROSTATE URINARY BLADDER BREAST etc.
- 5. WHAT IS TMT IN BLADDER CANCER? The fundamental treatment strategy of TMT entails performing maximum transurethral resection of bladder tumor (TURBT) followed by concurrent administration of chemotherapy and radiation therapy.
- 6. THE RADICAL CYSTECTOMY MALE
- 7. THE RADICAL CYSTECTOMY FEMALE
- 9. LET'S GO BY EVIDENCE
- 11. Dual treatment- double toxicity
- 15. What should I look for? Recurrence Overall survival Toxicity QOL
- 17. Gold is old Let’s search for diamond
- 18. Forest plot analysis X treatment Y treatment X treatment Y treatment X treatment Y treatment
- 19. The meta-analysis included 53,983 bladder cancer patients, with 5,721 from the TMT group and 48,262 from the RC group.
- 20. (A) T stage ≤ 2, (B) T stage > 2
- 21. C) ECOG = 0, and (D) ECOG ≥ 1.
- 22. Overall survival
- 23. overall survival in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC) at 12 (A), 24 (B), 36 (C)
- 24. overall survival in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC) at 48 (D), 60 (E), and 72 (F) months.
- 25. Forest plot comparing cancer-specific survival (CSS) in patients receiving trimodal therapy (TMT) vs. radical cystectomy (RC). (A) Pooled hazard ratio (HR); (B) Pooled odds ratio (OR).
- 27. Overall, this meta-analysis demonstrates that the efficacy of TMT is non-inferior to that of RC at to TMT at more than 10- year OS. Therefore, TMT may be a reasonable treatment option in well-selected patients who are unsuitable for surgery or are not willing to experience surgery. In the future, more high-quality, large- sample RCTs are needed to verify the results
- 30. The study involved 722 patients with clinical stage T2–T4N0M0 muscle-invasive urothelial carcinoma Among the 722 patients, 440 underwent radical cystectomy and 282 received trimodality therapy;
- 36. Material and methods This cross-sectional bi-institutional study identified 226 patients with nonmetastatic cT2-cT4 MIBC, diagnosed in 1990 to 2011 Who were eligible for RC and were disease free for 2 years. Six validated QOL instruments were administered: EuroQOL EQ-5D, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire and EORTC MIBC module, Expanded Prostate Cancer Index Composite bowel scale, Cancer Treatment and Perception Scale, and Impact of Cancer, version 2. Multivariable analyses of the mean QOL scores were conducted using propensity score matching
- 37. Summary QOL Both TMT and RC resulted in acceptable long-term QOL outcomes in MIBC survivors. Compared with RC, TMT appears to be associated with greater general, bowel, and sexual QOL, higher informed decision-making scores, and fewer concerns about body image and the negative effects of cancer. No significant differences were found in patients’ concern about cancer control or regret regarding treatment choices. Ultimately, whether our findings translate into clinically meaningful differences requires prospective validation, because our study was limited by missing baseline QOL data and different follow-up times. Our results support the notion that TMT could represent a good alternative to RC for selected patients and highlights the need for multidisciplinary care of MIBC patients
- 39. BELIEVE IT CYSTECTOMY IS PRIMITIVE TREATMENT AND TMT IS PRIME TREATMENT NOW
- 41. Life is all about entertainment Entertainment Radiation oncologist satisfied after organ preservation Entertainment Patient got gratification Entertainment – Uro-oncologist entertaining with family