Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study

Abstract

ObjectivesRadical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC.Material and methodsWe retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale.ResultsBetween 2000 and 2013, 57 patients [median age 66.3 years (45–84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2–33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4–50). A boost of 16 Gy (5–22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30–60), 37% (95%CI 24–51) and 49% (95%CI 33–63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context.ConclusionsBecause of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.

Supplementary granulocyte macrophage colony‐stimulating factor to chemotherapy and programmed death‐ligand 1 blockade decreases local recurrence after surgery in bladder cancer

“…Characteristics of 167 patients undergoing RC are depicted in Table S2. During follow up, 55 (33%) of 167 patients experienced recurrence with a median time from RC to diagnosis of 7 months (IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Positive RM were found in 20 patients (12%) consisting of five cases of pT3 disease and 15 pT4.…”

“…Local recurrence after RC has lethal potential and causes various symptoms including pain and hemorrhage. Many attempts have been made for the management of LR, including the development of risk stratification models, NAC, and adjuvant radiotherapy . Based on recent evidence that the addition of ICI to standard chemotherapy can result in significantly improved outcomes in treatment‐naive metastatic non‐small cell lung cancer, some phase II trials are ongoing to investigate the potential clinical benefits of GC chemotherapy combined with ICI for MIBC, such as NCT03294304 (nivolumab) and NCT02989584 (atezolizumab).…”

Patterns of Locoregional Recurrence after Radical Cystectomy for Stage T3-4 Bladder Cancer: A Radiation Oncologist's Point of View

“…The results from a French multicenter study reported 5.2% and 9% of Grade ≥3 acute and late GI toxicity, respectively. 23 Another study by Zaghloul, et al 24 also reported 7% of late Gr 3 GI toxicities.…”

The Role of Adjuvant Radiation Therapy in Locally Advanced Bladder Cancer

“…A recently published consensus contouring atlas for adjuvant bladder RT may help with standardization of target delineation for management of future patients and may lead to further improvements in patients treated with adjuvant RT [ 26 ]. A multi-institutional study from France has demonstrated good local control for patients with bladder cancer treated with adjuvant RT [ 27 ]. The authors reported using the Radiation Therapy Oncology Group (RTOG) atlas as a guide to define the Clinical Target Volume, suggesting that using published guidelines for target delineation can result in good clinical outcomes.…”