Bladder Sparing Approaches for Muscle-Invasive Bladder Cancers.

OPINION STATEMENT: Organ preservation has been increasingly utilised in the management of muscle-invasive bladder cancer. Multiple bladder preservation options exist, although the approach of maximal TURBT performed along with chemoradiation is the most favoured. Phase III trials have shown superiority of chemoradiotherapy compared to radiotherapy alone. Concurrent chemoradiotherapy gives local control outcomes comparable to those of radical surgery, but seemingly more superior when considering quality of life. Bladder-preserving techniques represent an alternative for patients who are unfit for cystectomy or decline major surgical intervention; however, these patients will need lifelong rigorous surveillance. It is important to emphasise to the patients opting for organ preservation the need for lifelong bladder surveillance as risk of recurrence remains even years after radical chemoradiotherapy treatment. No randomised control trials have yet directly compared radical cystectomy with bladder-preserving chemoradiation, leaving the age-old question of superiority of one modality over another unanswered. Radical cystectomy and chemoradiation, however, must be seen as complimentary treatments rather than competing treatments. Meticulous patient selection is vital in treatment modality selection with the success of recent trials within the field of bladder preservation only being possible through this application of meticulous selection criteria compared to previous decades. A multidisciplinary approach with radiation oncologists, medical oncologists, and urologists is needed to closely monitor patients who undergo bladder preservation in order to optimise outcomes

Prognostic value of baseline EORTC QLQ-C30 scores for overall survival across 46 clinical trials covering 17 cancer types: a validation study

Background A pooled data analysis by Quinten et al. (2009) found three European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) health-related quality of life (HRQoL) scales to be prognostic for survival: physical functioning, pain and appetite loss. This study aims to replicate these findings in an independent data set comprising a broader cancer population. Methods Data were obtained from 46 clinical trials across three cancer research networks conducted between 1996 and 2013 that assessed HRQoL using the EORTC QLQ-C30. A stratified Cox proportional hazards model was employed to assess the prognostic significance of baseline QLQ-C30 scale scores on overall survival, adjusting for socio-demographic and clinical variables. Stepwise model selection was done at 5% significance level. Model stability and prognostic accuracy were evaluated via bootstrapping and the C index respectively. Findings Data from 16,210 patients reporting HRQoL at baseline, spanning 17 cancer types, was used. The stratified multivariable model confirmed that better physical functioning (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.93–0.96), lower pain (HR, 1.02; 95% CI, 1.01–1.03), and appetite loss (HR, 1.04; 95% CI, 1.03–1.05) were significantly associated with survival. Additionally, global health status/QoL, dyspnoea, emotional and cognitive functioning were found to be prognostic for survival. This final model, encompassing sociodemographic, clinical, and HRQoL variables, achieved a corrected C index of 0.74, marking a 48% enhancement in discriminatory ability. Bootstrap evaluation indicated no major instability issues. Interpretation These results support previous findings that baseline physical functioning, pain, and appetite loss scores, along with four other scales from the EORTC QLQ-C30, predict survival in cancer patients

Baseline Assessment of Seagrass Communities of Lubang and Looc Islands, Occidental Mindoro, Philippines

The Lubang and Looc Islands in Occidental Mindoro are located west and form part of the Verde Island Passage (VIP), an ecologically important corridor linking the South China Sea and the Philippine internal waters. The VIP has also been labelled as a regional hotspot for tropical marine biodiversity, highlighting the need for management and conservation efforts that are science-based. Thus, this assessment was done to provide baseline data on the seagrass beds of the Lubang and Looc Islands. Thirteen sites were surveyed around the Lubang and Looc Islands, Occidental Mindoro on April 13 - 17, 2009. The seagrass beds are generally multispecific meadows that are characterized by both continuous and patchy meadows, with cover ranging from 0.62% to 59.49%. Eight seagrass species were observed, with Thalassia hemprichii and Cymodocea rotundata the most ubiquitous. Shoot densities observed in the area are generally high (mean = 961 shoots･m-2), and composite leaf biomass (mean = 212.70 gDW･m-2) is comparable to other seagrass beds surveyed in other sites in the country. The observed "kaingin" practices in the uplands pose the greatest threat to the seagrass ecosystems of the area because of the long-term domino effect of erosion and sedimentation on the seagrass beds. However, fisheries practices also need to be quantified to determine hierarchy of anthropogenic disturbance that causes habitat fragmentation of the seagrass beds of Lubang and Looc Islands