Palliative Radiation Therapy in Bladder Cancer—Importance of Patient Selection: A Retrospective Multicenter Study

Abstract

Palliative pelvic radiation therapy is an effective way to manage symptoms in patients with bladder cancer. This retrospective study investigates the role of palliative radiation therapy in this group of patients and highlights factors to consider as preventing patients from receiving futile treatment. These include performance status, comorbidities, and stage. We conclude that patient selection and Purpose: To investigate the effectiveness of palliative pelvic radiation therapy (PRT) in patients with bladder cancer and identify factors associated with treatment outcome. Methods and Materials: Patients with bladder cancer receiving PRT were identified retrospectively from 2 cancer centers between 2014 and 2017. Patients were stratified by age, stage, performance status, comorbidities, previous chemotherapy, previous radiation therapy, and radiation therapy protocol. Patients were followed up at 6 weeks after radiation therapy (RT). Median overall survival (mOS) from the last fraction of RT was calculated. Death within 30 days of RT or noncompletion of treatment were considered as futile treatment. Results: Two hundred forty-one patients were identified as receiving PRT. A variety of RT protocols were used: 8 Gy in 1 fraction (11%), 21 Gy in 3 fractions (15%), 20 Gy in 5 fractions (18%), 36 Gy in 6 fractions (36%), and 27.5 to 30 Gy in 8 to 10 fractions (18%). Thirty-eight percent of patients were of poor performance status (Eastern Cooperative Oncology Group performance status 3), and 46.5% had significant comorbidities (Adult Comorbidity Evaluation-27 2). The mOS from the last fraction of RT was 153 days (0-1289 days). The 30-day mortality after radiation therapy was 18% (n Z 44), and the rate of incomplete planned radiation therapy treatment was 14%

Palliative Radiation Therapy for Macroscopic Hematuria Caused by Urothelial Cancer

“…The efficacy of palliative RT for MH in patients with urological cancers has been reported in several retrospective studies. 3,4,6 In regard to the mechanism of hemostasis induced by RT, platelet aggregation, injury of vascular endothelial cells, and induction of vascular embolization has been considered the main underlying mechanisms, in addition to tumor shrinkage. 23,24 To obtain symptomatic relief or hemostasis, a high RT dose, as in definitive RT, is unnecessary.…”

“…4,26 Several studies have suggested that shortcourse RT was as efficient as RT administered in a higher number of fractions or long-course RT for obtaining bleeding control. 3,5,6,27 In a previously conducted retrospective study, 20 Gy in 5 fractions (n = 46), 30 Gy in 10 fractions (n = 25), and 8 Gy in a single fraction (n = 21) were the most commonly used regimens in 112 patients who were receiving palliative RT for the control of MH occurring from tumors. 27 Both longer RT regimens (>5 fractions) and shorter regimens (£5 fractions) exerted equal hemostatic effect ( p = 0.497) for an equal duration ( p = 0.652).…”

“…No statistically significant difference was observed with respect to the MH control rate at two weeks after the start of treatment (54% vs. 79%, p = 0.139) or rate of relapse of MH at six months (62% vs. 71%). 4 Recently, a retrospective study 3 was conducted in 241 patients from 2 centers to investigate the efficacy of palliative RT in patients with bladder cancer, in which 5 different RT protocols were used: 8 Gy in 1 fraction (11%), 21 Gy in 3 fractions (15%), 20 Gy in 5 fractions (18%), 36 Gy in 6 fractions (36%), and 27.5 to 30 Gy in 8 to 10 fractions (18%). The results showed no significant difference in the clinical outcomes among the five different RT protocols.…”

“…2 Palliative radiotherapy (RT) is sometimes used as a treatment option for hematuria, with the reported hematuria improvement rate varying from 54% to 92%. [3][4][5][6][7] A few reports of retrospective analyses of palliative RT for hematuria in patients with UCs have been published, and most are based on analyses of small cohorts. In 2016, a survey conducted by the palliative RT working group of the Japanese Radiation Oncology Study Group suggested that hemostatic irradiation is rarely performed at facilities in Japan and further that the number of fractions used varied significantly among facilities.…”

Nur die Chirurgie? Multimodalkonzepte mit kurativer Intention für das Urothelkarzinom der Harnblase

“…Eine RTX kann für multimorbide Patienten im schlechtem AZ, die unfit und ungeeignet für andere Therapiealternativen sind, eine Option mit potenziell kurativem Aspekt darstellen. Ebenso kann eine RTX in bis zu 53 % eine lokale Symptomkontrolle ermöglichen [47].…”