Perpetual role of brachytherapy in organ-sparing treatment for bladder cancer: a historical review

Quality of life of muscle-invasive bladder cancer patients after brachytherapy-based treatment: A cross-sectional study

Purpose

To determine the quality of life (QoL) of patients with muscle-invasive bladder cancer (MIBC) who underwent bladder-sparing treatment with high-dose-rate brachytherapy, and compare their QoL with an age-matched general Dutch population.

Material and methods

We conducted a single-center, prospective, descriptive cross-sectional study. MIBC patients who underwent brachytherapy-based bladder sparing treatment in Arnhem, The Netherlands from January 2016 to June 2021, were requested to complete the following questionnaires: European Organization for Research and Treatment of Cancer (EORTC) generic (QLQ-C30), bladder cancer-specific (QLQ-BLM30), and expanded prostate cancer index composite bowel (EPIC-50). Mean scores were calculated and compared with general Dutch population.

Results

The mean global health status/QoL score of the treated patients was 80.6. High scores were noted in the functional scales, including physical (86.8), role (85.6), emotional (88.6), cognitive (88.3), and social functioning (88.9), while the main reported complains were related to fatigue (21.9) and urinary symptoms (25.1). Compared to the general Dutch population, significant differences were visible in global health status/QoL (80.6 vs. 75.7), pain (9.0 vs. 17.8), insomnia (23.3 vs. 15.2), and constipation (13.3 vs. 6.8). However, in no case did the mean score differ by more than ten points, which was considered clinically relevant.

Conclusions

With a mean global health status/QoL score of 80.6, the patients after brachytherapy-based bladder sparing treatment have a good QoL. We found no clinically relevant difference in QoL comparing with an age-matched general Dutch population. The outcome strengthens the idea that this treatment option should be discussed with all patients eligible for brachytherapy-based treatment.

Function Preservation With Brachytherapy: Reviving the Art. Improving Quality of Life With Brachytherapy for Urological Malignancies

Brachytherapy for localised prostate, muscle-invasive bladder and penile cancer is well established, providing high tumour dose delivery and minimising normal tissue doses compared with external beam techniques. In prostate cancer, the main impact on quality of life relates to diminished sexual function and irritative or obstructive urinary symptoms, which are seen up to 15 years after treatment. Significant changes in bowel function are rare. Compared with radical prostatectomy or external beam radiotherapy, irritative or obstructive urinary symptoms are more prominent, whereas incontinence is less than after radical prostatectomy and bowel changes are less than after external beam radiotherapy. For muscle-invasive bladder cancer, when compared with radical cystectomy, although no difference is seen for urinary symptoms or fatigue, role and social functioning scores are higher and there is better post-treatment sexual function in both men and women. Compared with surgical treatment for penile cancer, brachytherapy results in better erectile function scores than after glansectomy and partial penectomy and high quality of life scores, with good satisfaction ratings for cosmetic appearance.

How Small Can We Go? Partial Bladder Radiation Therapy and Brachytherapy

Organ preservation for muscle-invasive bladder cancer (MIBC) may use trimodality therapy. This includes transurethral resection followed by radiation therapy. Radiosensitization has become one of the standard of care approaches for MIBC with high rates of local disease control and overall survival. The goal of organ preservation is to treat MIBC while preserving a well-functioning natural bladder. Debate remains over the best way to optimize radiation therapy in bladder cancer. In MIBC the role of partial cystectomy has been utilized in smaller solitary tumors with adequate local control and good urinary function. As radiation therapy techniques improve and modernize, smaller radiation volumes to a partial bladder may play an increasing role as we utilize imaging techniques coupled with adaptive radiation therapy planning and other techniques such as brachytherapy. In this review, we explore the use of brachytherapy and partial bladder fields of external beam radiation therapy in the treatment of MIBC.