1
|
Anzela A, Min M, Knesl M, Buddle N, Azzopardi M, Hooshmand R, Barrett S, Notman A, Woolls H, Wilson J, Vignarajah DD. Concurrent carbogen and nicotinamide with radiation therapy in muscle invasive bladder cancer: A report on feasibility in the Australian setting. J Med Imaging Radiat Oncol 2021; 65:768-777. [PMID: 34196122 DOI: 10.1111/1754-9485.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The incidence of bladder cancer increases with age, and elderly patients with muscle invasive bladder cancer (MIBC) are significantly undertreated. Bladder preservation trimodality therapy (BPTT) is an alternative to radical cystectomy in the curative setting. The use of concurrent carbogen and nicotinamide (CON) with radiation therapy (RT) as radiosensitisers have shown significant improvement in the overall survival and local relapse in the UK BCON Trial and is part of the standard of care for patients with MIBC in the UK. This is the first study in the Australian setting to demonstrate the feasibility in setting up a CON radiation oncology department. METHODS Based on the UK BCON trial, circuit systems for carbogen gas delivery were set up in consultation with the anaesthetics and respiratory teams. TGA exemption was obtained for 98% oxygen and 2% carbon dioxide carbogen gas mixture and delivery apparatus for each patient. Seven patients with histological locally advanced bladder cancer were recruited into this study. RESULTS The establishment of a CON department took approximately 24 months. Development of trial protocol was based on the equipment availability in Australia and proper transport, storage and handling of the equipment was guided by local occupational, health and safety (OHS) regulations. All patients received full of dose of CON. Increased urinary frequency, urgency and diarrhoea were the most commonly reported acute bladder and bowel toxicities. CONCLUSIONS This is the first study in Australia to demonstrate the feasibility of concurrent CON with radiation therapy. It is a safe and cost-effective treatment that provides a new therapeutic option in the treatment of patients with MIBC, particularly those with limited treatment options.
Collapse
Affiliation(s)
- Anzela Anzela
- Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia
| | - Myo Min
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,University of Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Marcel Knesl
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,Griffith University, Brisbane, Queensland, Australia
| | - Nicole Buddle
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Maree Azzopardi
- Department of Respiratory Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Riaz Hooshmand
- Griffith University, Brisbane, Queensland, Australia.,Department of Anaesthesia, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Salena Barrett
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Andria Notman
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Helen Woolls
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Jennifer Wilson
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Dharman Dinesh Vignarajah
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.,Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
|
3
|
Rödel C, Weiss C. Organ-sparing multimodality treatment for muscle-invasive bladder cancer: can we continue to ignore the evidence? J Clin Oncol 2014; 32:3787-8. [PMID: 25366679 DOI: 10.1200/jco.2014.58.5521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024] Open
Affiliation(s)
- Claus Rödel
- Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Weiss
- Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
4
|
Radical cystectomy vs. chemoradiation in T2-4aN0M0 bladder cancer: a case-control study. Urol Oncol 2014; 33:19.e1-19.e5. [PMID: 25445384 DOI: 10.1016/j.urolonc.2014.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/08/2014] [Accepted: 09/21/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Muscle-invasive bladder cancer is most commonly treated by radical cystectomy. Patients who are too sick to go through this surgery or who are unwilling to accept the mutilation associated with it are referred to chemoradiation. We compared the results of these 2 modalities using age-matched populations. PARTICIPANTS AND METHODS Between 1998 and 2008, 33 patients were treated with chemoradiation for biopsy-proven T2-4aN0M0 urothelial bladder cancer. For every patient treated with chemoradiation, an age-matched patient who underwent radical cystectomy on the same year was selected for comparison. Mean radiotherapy dose was 62 Gy (standard deviation = 8.4) and median follow-up of both groups was approximately 36 months. RESULTS The groups were similar in age, proportion of men, and length of follow-up. However, the Charlson comorbidity index was significantly lower for operated patients (3.45 vs. 4.36, P = 0.01). Furthermore, 2 patients (6%) in the chemoradiation group had salvage cystectomy (one for disease recurrence and another for bladder shrinkage). The 2- and 5-year overall survival rates after surgery were 74.4% and 54.8%, respectively, and after chemoradiation were 70.2% and 56.6% (P = 0.8), respectively. The 2- and 5-year disease-free survival rates after surgery were 67.8% and 63.2%, respectively, and after chemoradiation were 63% and 54.3% (P = 0.89), respectively. Side effects were mild in both groups, with grade 3+toxicity seen in only 2 operated and 4 irradiated patients. CONCLUSIONS Despite having a significantly higher comorbidity index, patients treated with chemoradiation had similar overall and disease-free survival rates with low toxicity. Treatment with chemoradiation should be considered in patients with T2-4aN0M0 bladder cancer.
Collapse
|
5
|
Aluwini S, van Rooij PHE, Kirkels WJ, Boormans JL, Kolkman-Deurloo IKK, Wijnmaalen A. Bladder function preservation with brachytherapy, external beam radiation therapy, and limited surgery in bladder cancer patients: Long-term results [corrected]. Int J Radiat Oncol Biol Phys 2014; 88:611-7. [PMID: 24411629 DOI: 10.1016/j.ijrobp.2013.11.227] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To report long-term results of a bladder preservation strategy for muscle-invasive bladder cancer (MIBC) using external beam radiation therapy and brachytherapy/interstitial radiation therapy (IRT). METHODS AND MATERIALS Between May 1989 and October 2011, 192 selected patients with MIBC were treated with a combined regimen of preoperative external beam radiation therapy and subsequent surgical exploration with or without partial cystectomy and insertion of source carrier tubes for afterloading IRT using low dose rate and pulsed dose rate. Data for oncologic and functional outcomes were prospectively collected. The primary endpoints were local recurrence-free survival (LRFS), bladder function preservation survival, and salvage cystectomy-free survival. The endpoints were constructed according to the Kaplan-Meier method. RESULTS The mean follow-up period was 105.5 months. The LRFS rate was 80% and 73% at 5 and 10 years, respectively. Salvage cystectomy-free survival at 5 and 10 years was 93% and 85%. The 5- and 10-year overall survival rates were 65% and 46%, whereas cancer-specific survival at 5 and 10 years was 75% and 67%. The distant metastases-free survival rate was 76% and 69% at 5 and 10 years. Multivariate analysis revealed no independent predictors of LRFS. Radiation Therapy Oncology Group grade ≥3 late bladder and rectum toxicity were recorded in 11 patients (5.7%) and 2 patients (1%), respectively. CONCLUSIONS A multimodality bladder-sparing regimen using IRT offers excellent long-term oncologic outcome in selected patients with MIBC. The late toxicity rate is low, and the majority of patients preserve their functional bladder.
Collapse
Affiliation(s)
- Shafak Aluwini
- Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands.
| | - Peter H E van Rooij
- Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands
| | - Wim J Kirkels
- Department of Urology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands
| | | | - Arendjan Wijnmaalen
- Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Koning CCE, Blank LECM, Koedooder C, van Os RM, van de Kar M, Jansen E, Battermann JJ, Beijert M, Gernaat C, van Herpen KAM, Hoekstra C, Horenblas S, Jobsen JJ, Krol ADG, Lybeert MLM, van Onna IEW, Pelger RCM, Poortmans P, Pos FJ, van der Steen-Banasik E, Slot A, Visser A, Pieters BR. Brachytherapy after external beam radiotherapy and limited surgery preserves bladders for patients with solitary pT1-pT3 bladder tumors. Ann Oncol 2012; 23:2948-2953. [PMID: 22718135 DOI: 10.1093/annonc/mds126] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Several French, Belgian and Dutch radiation oncologists have reported good results with the combination of limited surgery after external beam radiotherapy (EBRT) followed by brachytherapy in early-stage muscle-invasive bladder cancer. PATIENTS AND METHODS Data from 12 of 13 departments which are using this approach have been collected retrospectively, in a multicenter database, resulting in 1040 patients: 811 males and 229 females with a median age of 66 years, range 28-92 years. Results were analyzed according to tumor stage and diameter, histology grade, age and brachytherapy technique, continuous low-dose rate (CLDR) and pulsed dose rate (PDR). RESULTS At 1, 3 and 5 years, the local recurrence-free probability was 91%, 80% and 75%, metastasis-free probability was 91%, 80% and 74%, disease-free probability was 85%, 68% and 61% and overall survival probability was 91%, 74% and 62%, respectively. The differences in the outcome between the contributing departments were small. After multivariate analysis, the only factor influencing the local control rate was the brachytherapy technique. Toxicity consisted mainly of 24 fistula, 144 ulcers/necroses and 93 other types. CONCLUSIONS EBRT followed by brachytherapy, combined with limited surgery, offers excellent results in terms of bladder sparing for selected groups of patients suffering from bladder cancer.
Collapse
Affiliation(s)
- C C E Koning
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam.
| | - L E C M Blank
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - C Koedooder
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - R M van Os
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - M van de Kar
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - E Jansen
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| | - J J Battermann
- Departments of Radiation Oncology and Urology, University Medical Centre Utrecht, Utrecht
| | - M Beijert
- Department of Radiation Oncology, University Medical Centre Groningen, Groningen
| | - C Gernaat
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede
| | | | - C Hoekstra
- Radiotherapeutic Institute RISO, Department of Radiation Oncology, Deventer
| | - S Horenblas
- The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Departments of Urology and Radiation Oncology, Amsterdam
| | - J J Jobsen
- Department of Radiation Oncology, Medisch Spectrum Twente, Enschede
| | - A D G Krol
- Department of Radiation Oncology, University Medical Centre Leiden, Leiden
| | - M L M Lybeert
- Department of Radiation Oncology, Catharina Hospital Eindhoven
| | | | - R C M Pelger
- Department of Urology, University Medical Centre Leiden, Leiden
| | - P Poortmans
- Institute Verbeeten, Department of Radiation Oncology, Tilburg
| | - F J Pos
- The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Departments of Urology and Radiation Oncology, Amsterdam
| | | | - A Slot
- Radiotherapeutic Institute Friesland (RIF), Leeuwarden, The Netherlands
| | - A Visser
- Arnhem Radiotherapeutic Institute (ARTI), Arnhem
| | - B R Pieters
- Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
| |
Collapse
|
7
|
Azuma H, Inamoto T, Takahara K, Ibuki N, Nomi H, Yamamoto K, Narumi Y, Ubai T. Neoadjuvant and adjuvant chemotherapy for locally advanced bladder carcinoma: development of novel bladder preservation approach, Osaka Medical College regimen. Int J Urol 2011; 19:26-38. [PMID: 22077821 DOI: 10.1111/j.1442-2042.2011.02856.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cisplatin-based chemotherapy has been widely used in a neoadjuvant as well as adjuvant setting. Furthermore, trimodal approaches including complete transurethral resection of the bladder tumor followed by combined chemotherapy and radiation have generally been performed as bladder preservation therapy. However, none of the protocols have achieved a 5-year survival rate of more than 70%. Additionally, the toxicity of chemotherapy and/or a decreased quality of life due to urinary diversion cannot be ignored, as most patients with bladder cancer are elderly. We therefore newly developed the novel trimodal approach of "combined therapy using balloon-occluded arterial infusion of anticancer agent and hemodialysis with concurrent radiation, which delivers an extremely high concentration of anticancer agent to the site of a tumor without systemic adverse effects ("Osaka Medical College regimen" referred to as the OMC regimen). We initially applied the OMC regimen as neoadjuvant chemotherapy for locally advanced bladder cancer. However, since more than 85% of patients with histologically-proven urothelial cancer achieved complete response with no evidence of recurrence after a mean follow-up of 170 (range 21-814) weeks, we have been applying the OMC-regimen as a new approach for bladder sparing therapy. We summarize the advantage and/or disadvantage of chemotherapy in neoadjuvant as well as adjuvant settings, and show the details of our newly developed bladder sparing approach OMC regimen in this review.
Collapse
Affiliation(s)
- Haruhito Azuma
- Departments of Urology, Osaka Medical College, Takatsuki, Osaka, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Hoskin PJ, Rojas AM, Bentzen SM, Saunders MI. Radiotherapy With Concurrent Carbogen and Nicotinamide in Bladder Carcinoma. J Clin Oncol 2010; 28:4912-8. [DOI: 10.1200/jco.2010.28.4950] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Phase II clinical studies suggest that hypoxic modification with carbogen and nicotinamide (CON) may increase the efficacy of radiotherapy (RT). Patients and Methods Three hundred thirty-three patients with locally advanced bladder carcinoma were randomly assigned to RT alone versus RT with CON. A schedule of either 55 Gy in 20 fractions in 4 weeks or 64 Gy in 32 fractions in 6.5 weeks was used. The primary end point was cystoscopic control at 6 months (CC6m) and secondary end points were overall survival (OS), local relapse-free survival (RFS), urinary and rectal morbidity. Results CC6m was 81% for RT + CON and 76% for RT alone (P = .3); however, just more than half of patients underwent cystoscopy at that time. Three-year estimates of OS were 59% and 46% (P = .04) and 3-year estimates of RFS were 54% and 43% (P = .06) for RT + CON versus RT alone. Risk of death was 14% lower with RT + CON (P = .04). In multivariate comparison, RT + CON significantly reduced the risk of relapse (P = .05) and death (P = .03). There was no evidence that differences in late urinary or GI morbidity between treatment groups or between fractionation schedules were significant. Conclusion RT + CON produced a small nonsignificant improvement in CC6m. Differences in OS, risk of death, and local relapse were significantly in favor of RT + CON. Late morbidity was similar in both trial arms. Results indicate a benefit of adding CON to radical RT.
Collapse
Affiliation(s)
- Peter J. Hoskin
- From the Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex; University College London, London, United Kingdom; and the University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ana M. Rojas
- From the Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex; University College London, London, United Kingdom; and the University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Søren M. Bentzen
- From the Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex; University College London, London, United Kingdom; and the University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michele I. Saunders
- From the Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex; University College London, London, United Kingdom; and the University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
9
|
Bladder-preserving therapy for muscle-invasive bladder cancer: should it be recommended to appropriate patients? Curr Urol Rep 2008; 9:257-8. [PMID: 18765122 DOI: 10.1007/s11934-008-0044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
10
|
Kotwal S, Choudhury A, Johnston C, Paul AB, Whelan P, Kiltie AE. Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom specialist treatment center. Int J Radiat Oncol Biol Phys 2007; 70:456-63. [PMID: 17904301 DOI: 10.1016/j.ijrobp.2007.06.030] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 06/06/2007] [Accepted: 06/20/2007] [Indexed: 01/28/2023]
Abstract
PURPOSE To conduct a retrospective analysis within a large university teaching hospital, comparing outcomes between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer. PATIENTS AND METHODS Between March 1996 and December 2000, 169 patients were treated radically for muscle-invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgical outcome data. RESULTS There was no difference in overall, cause-specific, and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31 local bladder recurrences in the radiotherapy group (24 solitary), but there was no significant difference in distant recurrence-free survival. In a more recent (2002-2006) cohort, the median age of radiotherapy patients but not the cystectomy patients was higher than in the 1996-2000 cohort (78.4 years vs. 75.3 years for radiotherapy and 67.9 years vs. 68.2 years for surgery). CONCLUSIONS Although the patients undergoing radical cystectomy were significantly younger than the radiotherapy patients, treatment modality did not influence survival. Bladder cancer patients are an increasingly elderly group. Radical radiotherapy is a viable treatment option for these patients, with the advantage of organ preservation.
Collapse
Affiliation(s)
- Sanjeev Kotwal
- Pyrah Department of Urology, St. James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | | | | | | |
Collapse
|
11
|
Tonoli S, Bertoni F, De Stefani A, Vitali E, De Tomasi D, Caraffini B, Scheda A, Bertocchi M, Somensari A, Buglione M, Magrini SM. Radical Radiotherapy For Bladder Cancer: Retrospective Analysis of a Series of 459 Patients Treated in an Italian Institution. Clin Oncol (R Coll Radiol) 2006; 18:52-9. [PMID: 16477920 DOI: 10.1016/j.clon.2005.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To contribute to the available evidence about the efficacy of exclusive radiotherapy for bladder cancer through a retrospective analysis of a large series of patients consecutively treated in a single institution. MATERIALS AND METHODS A total of 459 patients with UICC categories T1-T4, N0-Nx and M0 bladder cancer consecutively treated with radiotherapy alone with radical intent formed the clinical basis for this study. Many of them (and particularly the T1 cases) had poor medical conditions or were unfit for surgery. About half of the cases (54%) had a T2 tumour, and about 18% had T3-T4 disease. Eighty per cent of the cases received minimal doses in the target volume in the range 60-70 Gy; pelvic lymph nodes were treated in 34%. Simple radiotherapy techniques were used in most cases. Average follow-up for living patients was 4.4 years. Results were analysed according to number and type of relapses: overall survival, disease-specific survival, failure-free survival probability, acute and late toxicity (RTOG scale). RESULTS Actuarial 5-year overall survival, disease-specific survival and failure-free survival rates at 5 years for the entire series were 36%, 56%, 33%, respectively. Age, T category (for all the end points) and tumour dose (only for failure-free survival) were significantly related to prognosis at multivariate survival analysis. Late enteric toxicity (6.1% of the cases) was significantly linked with the treated volumes (univariate analysis). Urinary late toxicity (23% of cases) was linked with age and T category (multivariate analysis). In both cases, toxicity was mostly Grade 1 or 2. CONCLUSIONS The results of radiotherapy in this negatively selected series, accrued over a long period of time in patients treated with unsophisticated techniques, are reasonably good; they add to the evidence available to support the use of modern bladder-sparing programmes, including the association of chemo- and radiotherapy.
Collapse
Affiliation(s)
- S Tonoli
- Radiation Oncology Department, Brescia University and Istituto del Radio 'O.Alberti', Spedali Civili, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Pos FJ, Hart G, Schneider C, Sminia P. Radical radiotherapy for invasive bladder cancer: What dose and fractionation schedule to choose? Int J Radiat Oncol Biol Phys 2006; 64:1168-73. [PMID: 16376486 DOI: 10.1016/j.ijrobp.2005.09.023] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 09/12/2005] [Accepted: 09/13/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To establish the alpha/beta ratio of bladder cancer from different radiotherapy schedules reported in the literature and provide guidelines for the design of new treatment schemes. METHODS AND MATERIALS Ten external beam radiotherapy (EBRT) and five brachytherapy schedules were selected. The biologically effective dose (BED) of each schedule was calculated. Logistic modeling was used to describe the relationship between 3-year local control (LC3y) and BED. RESULTS The estimated alpha/beta ratio was 13 Gy (95% confidence interval [CI], 2.5-69 Gy) for EBRT and 24 Gy (95% CI, 1.3-460 Gy) for EBRT and brachytherapy combined. There is evidence for an overall dose-response relationship. After an increase in total dose of 10 Gy, the odds of LC3y increase by a factor of 1.44 (95% CI, 1.23-1.70) for EBRT and 1.47 (95% CI, 1.25-1.72) for the data sets of EBRT and brachytherapy combined. CONCLUSION With the clinical data currently available, a reliable estimation of the alpha/beta ratio for bladder cancer is not feasible. It seems reasonable to use a conventional alpha/beta ratio of 10-15 Gy. Dose escalation could significantly increase local control. There is no evidence to support short overall treatment times or large fraction sizes in radiotherapy for bladder cancer.
Collapse
Affiliation(s)
- Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
13
|
Pos F, Horenblas S, Dom P, Moonen L, Bartelink H. Organ preservation in invasive bladder cancer: Brachytherapy, an alternative to cystectomy and combined modality treatment? Int J Radiat Oncol Biol Phys 2005; 61:678-86. [PMID: 15708245 DOI: 10.1016/j.ijrobp.2004.06.249] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Revised: 06/18/2004] [Accepted: 06/28/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate our long-term results of bladder preservation with brachytherapy in the treatment of bladder cancer. METHODS AND MATERIALS Between 1987 and 2000, 108 patients with T1-G3 and T2-T3a stages of bladder cancer were treated with a transurethral resection (TUR) and a course of external beam radiotherapy (30 Gy in 15 fractions) followed by brachytherapy (40 Gy). All tumors were solitary lesions with a diameter < or =5 cm. Median follow-up was 54 months (range, 1-178 months). RESULTS The 5-year and 10-year overall survival rates were 62% and 50%, respectively. The 5-year and 10-year disease-specific survival rates were 73% and 67%, respectively. The actuarial local control rate was 73% at 5 and 73% at 10 years, respectively. The 5-year and 10-year disease-specific survival rates for patients with a preserved bladder were 68% and 59%, respectively. Of all long-term surviving patients, 90% preserved their native bladders. The treatment was well tolerated. Acute toxicity was mild. Two patients experienced serious late toxicity: 1 patient developed a persisting vesicocutaneous fistula and the other a stricture of the urethra and ureters. CONCLUSION For patients with solitary, organ confined invasive bladder cancer < or =5 cm, bladder preservation with brachytherapy is an excellent alternative to radical cystectomy and combined modality treatment.
Collapse
Affiliation(s)
- Floris Pos
- Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
14
|
Herman JM, Smith DC, Montie J, Hayman JA, Sullivan MA, Kent E, Griffith KA, Esper P, Sandler HM. Prospective quality-of-life assessment in patients receiving concurrent gemcitabine and radiotherapy as a bladder preservation strategy. Urology 2004; 64:69-73. [PMID: 15245938 DOI: 10.1016/j.urology.2004.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2003] [Accepted: 02/18/2004] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess, in a Phase I study, whether bladder preservation with concurrent gemcitabine and radiotherapy (RT) influenced patient-reported quality of life (QOL) as determined by the Functional Assessment of Cancer Therapy-Bladder (FACT-BL). METHODS Between January 1998 and March 2002, 24 patients with urothelial carcinoma of the bladder were enrolled, and 23 patients underwent transuretheral resection of bladder tumor, followed by twice-weekly gemcitabine with concurrent RT. The initial dose was 10 mg/m2 given twice weekly and increased as tolerated. To assess treatment-related QOL, patients completed the FACT-BL questionnaire. RESULTS Of the 24 patients enrolled, 23 (96%) were assessed for toxicity and response. The FACT-generic (G) QOL assessment was obtained from 22 (92%) of 23 patients. No statistically significant difference was found in the FACT-G or FACT-BL or the combination before, during, or after treatment. The FACT-BL values were lower in patients who received higher doses of gemcitabine (greater than 20 mg/m2 versus 20 mg/m2 or less). At least one dose-limiting toxicity (DLT) was experienced by 5 (23%) of 22 patients. The FACT-G values were lower for those patients who experienced DLT (difference of -13.1, P = 0.07). The physical well-being scores for patients who experienced DLT were lower after treatment (difference of -5.2, P = 0.03) compared with those without DLT. CONCLUSIONS Concurrent RT and gemcitabine failed to statistically influence patient-reported QOL, although patients who received higher doses reported lower FACT-BL scores. The results of this study suggest that concurrent gemcitabine with conformal RT is a tolerable treatment regimen for bladder preservation, as demonstrated by the excellent treatment compliance and similar FACT measurements.
Collapse
Affiliation(s)
- Joseph M Herman
- Department ofRadiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Mead GM, Roberts JT. The role of the nonsurgical oncologist in the management of advanced transitional cell cancer. Part I: locally advanced disease. BJU Int 2004; 94:977-80. [PMID: 15541112 DOI: 10.1111/j.1464-410x.2004.05089.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Graham M Mead
- Department of Medical Oncology, Royal South Hants Hospital, Southampton, UK
| | | |
Collapse
|
16
|
Tsukamoto T, Kitamura H, Takahashi A, Masumori N. Treatment of invasive bladder cancer: lessons from the past and perspective for the future. Jpn J Clin Oncol 2004; 34:295-306. [PMID: 15333680 DOI: 10.1093/jjco/hyh048] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Radical cystectomy with lymphadenectomy is the gold standard for treatment of invasive bladder cancer. However, the treatment alone does not always provide a satisfactory result for the disease extending outside the bladder. In this review we discuss several clinical issues in the diagnosis and treatment of this invasive disease. Although the quality of diagnostic imaging modalities has improved, they are still not sensitive enough for the staging of the disease, especially for early invasive disease. In addition, lack of serum markers hinders appropriate monitoring of patients with the disease. Regarding the surgical aspect of lymphadenectomy, the area of its dissection, the standard number of nodes retrieved and the method of pathological examination should be established so that the clinical benefits of surgery can be more clearly defined. Neoadjuvant chemotherapy for invasive disease is promising for improvement of survival of patients. A chemotherapy regimen as effective as, but less toxic than, MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) has been reported and several phase III clinical trials have been launched to determine the benefits of adjuvant or neoadjuvant chemotherapy with newly developed agents. However, we still lack a chemotherapy regimen more effective than MVAC, which is the most crucial issue in the treatment of this invasive disease. An alternative option for such disease may be bladder preservation with transurethral resection of tumor followed by chemoradiotherapy. However, patients who are indicated for this treatment may be limited to those with early invasive disease having certain favorable clinical and pathological features.
Collapse
Affiliation(s)
- Taiji Tsukamoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | | | | | | |
Collapse
|