Bladder-sparing treatment including radiotherapy plus transurethral resection has become more popular recently, particularly for elderly patients and those with significant comorbidities (1, 2). Radical cystectomy, which is still considered the standard approach in many institutions, is associated with a considerable risk of significant complications including perioperative death (3-5).Although multimodality treatment including transurethral resection of tumour followed by radiotherapy ideally supplemented with simultaneous chemotherapy is less invasive than radical cystectomy, it is still a challenging treatment regimen and may not be tolerated by many patients with bladder cancer (1). To avoid over-or undertreatment of patients, the treatment regimen should be optimally tailored to each patient's situation. Such an individualized approach should consider several aspects, including the patient's survival prognosis. However, estimation of the remaining lifespan is often difficult for the treating physician and would be facilitated with a simple prognostic tool that can be easily used during clinical routine and provides the physician the ability to predict a patient's survival time.This study was conducted to create just such a predictive tool, created for patients with bladder cancer who cannot or do not wish to undergo radical cystectomy and prefer a bladder-preserving approach including radiotherapy and upfront transurethral resection of the bladder tumour.
Patients and MethodsEight clinical parameters were retrospectively evaluated for potential correlation with overall survival (OS) in 42 patients undergoing transurethral resection of the bladder plus subsequent radiotherapy for primary treatment of non-metastatic bladder cancer (Table I). All patients had received an equivalent dose in 2 Gy-fractions of >55 Gy. The radiation regimen was 59.4 Gy in 33 fractions of 1.8 Gy in 37 patients, 57.8 Gy in 32 fractions of 1.8 Gy in two patients, 56 Gy in 28 fractions of 2.0 Gy in one, 60 Gy in 30 fractions of 2.0 Gy in one and 63 Gy in 35 fractions of 1.8 Gy in one, respectively. Thirty-two patients (76%) received chemotherapy during the radiotherapy course. The chemotherapy included cisplatin alone in 15, paclitaxel alone in 11, cisplatin/paclitaxel in three, carboplatin alone in two and vinflunine alone in one.Those clinical parameter that were found to be significantly associated (p<0.05) with OS on both univariate (Kaplan-Meier estimates plus log-rank test) and multivariate analyses (Cox regression model) were included in the prognostic tool. The tool was designed to predict an individual patient's OS-probability at 3 years following radiotherapy. It was based on the 3-year OS-rates of those clinical parameters which were significantly associated with OS on univariate and multivariate analyses of this study,
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