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

Status: Recruiting
Diagnosis: Bladder Cancer
NCT ID: NCT01224665 (View complete trial on
DFCI Protocol ID: 13-197


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.


Conducting Institutions:
Brigham and Women's Hospital

Overall PI:
Adam Kibel, MD, Brigham and Women's Hospital

Site-responsible Investigators:

Brigham and Women's Hospital: Michael Meyers,

Eligibility Criteria

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
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