The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery

Abstract

Objective: The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. Patients and Methods: Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. Results: At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle--invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. Conclusions: Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.

A retrospective study of the effectiveness of hemostatic radiotherapy with conventional fractionation in patients with advanced cancer

“…Locarriere et al reported that 22 of 32 patients (69%) who had received 20 Gy in 5 fractions or 30 Gy in 10 fractions became hematuria-free after RT; the response rate of patients who received 20 Gy in 5 fractions was 79% [9]. For gynecological cancer, the response rate was 100% (4 of 4 patients) in our study.…”

Survival outcomes for patients with localised upper tract urothelial carcinoma managed with non‐definitive treatment

“…For patients with development of symptoms, e.g. haematuria, local treatment may be feasible with radiation or embolisation . For patients who are placed on watchful waiting and develop systemic progression, metastatic UC is uniformly fatal.…”

Palliative radiation therapy of bladder cancer

“…Lacarriиre и соавт. провели сравнительную оценку эффективности 2 режимов фракционирова-ния: РОД 3 Гр, 10 фракций до СОД 30 Гр у 13 больных РМП и РОД 4 Гр, 5 фракций до СОД 20 Гр в течение недели у 19 пациентов [18]. Через 2 нед после начала ДЛТ купирование гематурии отмечено в 69 % случаев, при этом в 1-й группе -в 54 %, а во 2-й группе -в 79 % случаев.…”

“…Представлены результаты применения различных режимов ГФ: РОД 8,5-7,0 Гр, 2-3 фракции до СОД 17-21 Гр [8][9][10][11]; РОД 5-6 Гр, 1 или 2 фракции в неде-лю до СОД 30-36 Гр [12][13][14][15][16]; а также РОД 3,0-3,5 Гр, 10 фракций до СОД 30-35 Гр [9,17,18]. Как следует из опубликованных данных, применение подобных схем ДЛТ у больных РМП позволяет достичь палли-ативного эффекта в 40-70 % случаев.…”