commentary

Mitigating pelvic recurrence and improving overall survival

Bobby Shayegan, MD, FRCSC

Department of Surgery, McMaster University, Hamilton, ON, Canada

Cite as: Can Urol Assoc J 2016;10(3-4):95. http://dx.doi.org/10.5489/cuaj.3772

Assuming that PR is inﬂuenced by both patient, as well

as treatment-related events, and given that the former can-

not be modiﬁed, the focus continues to be on optimizing

our treatment outcomes. Unfortunately, from a systemic

standpoint, the use of neoadjuvant chemotherapy does not

appear to inﬂuence PR following cystectomy. The adequacy

of surgery and extent of pelvic lymphadenectomy continue

to be areas of active interest in mitigating PR and improving

overall survival. Importantly, the NRG-GU001 randomized,

phase 2 trial of postoperative adjuvant intensity modulated

radiotherapy is poised to answer whether radiotherapy can

reduce PR in those at-risk for its development (pT3-4pN0-2).

See related article on page 90.

n their study, Eapen et al have highlighted the ongoing

and signiﬁcant problem of pelvic recurrence (PR) follow-

ing radical cystectomy for urothelial carcincoma of the

bladder. In keeping with literature to date, PR was deﬁned

as recurrence of disease within soft tissues in the region of

surgical resection or lymph node recurrence in the region

of pelvic lymph node dissection below the level of aortic

bifurcation. It is well-recognized that prognosis in this cohort

of patients is uniformly poor, with median survivals ranging

from 4‒8 months from diagnosis despite treatment.

Competing interests: The author declares no competing ﬁnancial or personal interests.

The patient cohort in the current study was captured using

a survey approach involving 111 patients across 10 institu-

tions in Canada. Overall, 11.7% had PR only, which is in

keeping with a PR rate of 5‒15% in contemporary cystec-

tomy cohorts. However, if those with concomitant distant

metastases (DM) are to be included, a total of 34.2% patients

were assessed to have PR. This distinction is an important

one, given that in those with DM, it is possible, and likely,

that PR preceded DM. Unfortunately, given the size and

nature of this study, it is not reasonable to ascertain patient

and treatment risk factors for PR and DM.

Reference

Eapen LJ, Jones E, Kassouf W, et al. Enumerating pelvic recurrence following radical cystectomy for

bladder cancer: A Canadian multi-institutional study. Can Urol Assoc J 2016;10(3-4):90-4. http://

dx.doi.org/10.5489/cuaj.3456

Correspondence: Dr. Bobby Shayegan, McMaster University, Hamilton, ON, Canada;

shayeb@mcmaster.ca

CUAJ • March-April 2016 • Volume 10, Issues 3-4

2016 Canadian Urological Association