Whole-Pelvis or Bladder-Only Chemoradiation for Lymph Node–Negative Invasive Bladder Cancer: Single-Institution Experience

Tunio, Mutahir A.; Hashmi, Altaf; Qayyum, Abdul; Mohsin, Rehan; Ahmed, Zaeem

doi:10.1016/j.ijrobp.2011.05.051

Cited by 132 publications

(73 citation statements)

References 20 publications

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“…Five-year survival for patients with T3-T4 disease was shown to be 53% (compared to 74% for T2 disease) in a single-centre study. 217 Multifocal CIS patients are not good candidates for radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Kassouf

Aprikian

Black

et al. 2016

CUAJ

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This initiative was undertaken in response to concerns regarding the variation in management and in outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. Population-based data have also revealed that real-life survival is lower than expected based on data from clinical trials and/or academic centres. To address these perceived shortcomings and attempt to streamline and unify treatment approaches to bladder cancer in Canada, a multidisciplinary panel of expert clinicians was convened last fall for a two-day working group consensus meeting. The panelists included urologic oncologists, medical oncologists, radiation oncologists, patient representatives, a genitourinary pathologist, and an enterostomal therapy nurse. The following recommendations and summaries of supporting evidence represent the results of the presentations, debates, and discussions. Methodology

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Section: Discussionmentioning

confidence: 99%

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Kassouf

Aprikian

Black

et al. 2016

CUAJ

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“…Among the patients who achieved a CR, the incidence of pelvic lymph node recurrence was 15.8% and 17.6%, respectively. 53 Thus, whole pelvis irradiation at induction CRT is unlikely to reduce pelvic recurrences compared with bladder-only irradiation. Because of the limited effect of induction CRT on pelvic lymph node micrometastasis, cura-tive intervention to the regional lymph nodes might improve the prognosis of patients treated with a bladder-sparing approach.…”

Section: Pelvic Recurrencementioning

confidence: 99%

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Koga

Kihara

2012

Int J of Urology

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Abbreviations & Acronyms BIS = bladder-intact survival CIS = carcinoma in situ CR = complete response CRT = chemoradiotherapy CSS = cancer-specific survival FU = fluorouracil GasLESS = gasless laparoendoscopic single-port surgery GC = gemcitabine, cisplatin HD = hemodialysis IAC = intra-arterial chemotherapy IMRT = intensity-modulated radiation therapy LCRT = low-dose chemoradiotherapy MCV = methotrexate, cisplatin and vinblastine MIBC = muscle-invasive bladder cancer MRI = magnetic resonance imaging MVAC = methotrexate, vinblastine, adriamycin and cisplatin NA = not available NFkB = nuclear factor kB NMIBC = non-muscle-invasive bladder cancer OS = overall survival PC = partial cystectomy PLND = pelvic lymph node dissection QoL = quality of life RC = radical cystectomy RTOC = Radiation Therapy Oncology Group SPARE = Selective bladder Preservation Against Radical Excision TMDU = Tokyo Medical and Dental University TURBT = transurethral resection of bladder tumors Abstract: Radical cystectomy plus urinary diversion, the reference standard treatment for muscle-invasive bladder cancer, associates with high complication rates and compromises quality of life as a result of long-term effects on urinary, gastrointestinal and sexual function, and changes in body image. As a society ages, the number of elderly patients unfit for radical cystectomy as a result of comorbidity will increase, and thus the demand for bladder-sparing approaches for muscle-invasive bladder cancer will also inevitably increase. Trimodality bladder-sparing approaches consisting of transurethral resection, chemotherapy and radiotherapy (S55-65 Gy) yield overall survival rates comparable with those of radical cystectomy series (50-70% at 5 years), while preserving the native bladder in 40-60% of muscle-invasive bladder cancer patients, contributing to an improvement in quality of life for such patients. Limitations of the trimodality therapy include (i) muscle-invasive bladder cancer recurrence in the preserved bladder, which most often arises in the original muscle-invasive bladder cancer site; (ii) potential lack of curative intervention for regional lymph nodes; and (iii) increased morbidity in the event of salvage radical cystectomy for remaining or recurrent disease as a result of high-dose pelvic irradiation. Consolidative partial cystectomy with pelvic lymph node dissection followed by induction chemoradiotherapy at lower dose (e.g. 40 Gy) is a rational strategy for overcoming such limitations by strengthening locoregional control and reducing radiation dosage. Molecular profiling of the tumor and functional imaging might play important roles in optimal patient selection for bladder preservation. Refinement of radiation techniques, intensified concurrent or adjuvant chemotherapy, and novel sensitizers, including molecular targeting agent, are also expected to improve outcomes and consequently provide more muscle-invasive bladder cancer patients with favorable quality of life.

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“…The results of this survey revealed that the median total dose of RT was 60 Gy (range 30 -66 Gy), however, the RT protocol, including the RT field and the number of portals differed greatly among the institutions. Concerning the method of RT, it was thought that having a radiation field with the entire bladder or small pelvis was sufficient, although only one report of a single-institution experience randomized study was made regarding the radiation field (20), except that studies regarding the radiation dose were published (21 -24). The present study also failed to yield any significant results concerning the optimal radiation field.…”

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confidence: 99%

Patterns of Practice in the Radiation Therapy for Bladder Cancer: Survey of the Japanese Radiation Oncology Study Group (JROSG)

Maebayashi

Ishikawa

Yorozu

et al. 2014

Japanese Journal of Clinical Oncology

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Objective: To retrospectively analyze the clinical outcomes of radiation therapy with or without chemotherapy for bladder cancer in Japan. Methods: A questionnaire-based survey of patients with pathologically proven bladder cancer treated by definitive radiation therapy between 2002 and 2006 was conducted by the Japanese Radiation Oncology Study Group, and the clinical records of 159 patients were collected from 17 institutions. Concurrent intra-arterial chemoradiotherapy and concurrent systemic chemoradiotherapy were administered in 51 and 33 patients, respectively. Results: The 5-year overall survival and bladder preservation rates were 48 and 39%, respectively. Eighty-nine (56%) patients developed recurrence (bladder, 48; regional lymph nodes, 4; distant sites, 41). The results of multivariate analysis revealed that adoption of chemotherapy was the only significant prognostic factor for overall survival (relative risk ¼ 0.615 [95% confidence interval: 0.439 -0.862], P ¼ 0.005). The type of chemotherapy administered did not significantly affect the local control or overall survival rates. The actuarial 5-year overall survival rates and bladder preservation in the radiation therapy combined with intra-arterial chemotherapy group were 64 and 58%, respectively, and the corresponding rates in the radiation therapy combined with systemic chemotherapy group were 67 and 42%, respectively. Conclusions: The results of this survey revealed the current status of practice of radiation therapy for bladder cancer in Japan. A multi-institutional prospective study is needed based on the results of this study to determine the optimal radiotherapeutic approach, including the need for concurrent chemotherapy and the appropriate chemotherapy regimen for invasive bladder cancer.

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Whole-Pelvis or Bladder-Only Chemoradiation for Lymph Node–Negative Invasive Bladder Cancer: Single-Institution Experience

Cited by 132 publications

References 20 publications

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

Patterns of Practice in the Radiation Therapy for Bladder Cancer: Survey of the Japanese Radiation Oncology Study Group (JROSG)

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