Dataset Information

A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer.

ABSTRACT: Bladder preservation with trimodality treatment (TMT) is an alternative strategy to radical cystectomy (RC) for the management of localised muscle invasive bladder cancer (MIBC). TMT comprises of transurethral resection of the bladder tumour (TURBT) followed by radiotherapy with concurrent radiosensitisation. TMT studies have shown neo-adjuvant chemotherapy with cisplatin-based regimens is often given to further improve survival outcomes. A hypofractionated radiotherapy regimen is preferable due to its non-inferiority in local control and late toxicities. Radiosensitisation can comprise concurrent chemotherapy (with gemcitabine, cisplatin or combination fluorouracil and mitomycin), CON (carbogen and nicotinomide) or hyperthermic treatment. Radiotherapy techniques are continuously improving and becoming more personalised. As the bladder is a mobile structure subject to volumetric changes from filling, an adaptive approach can optimise bladder coverage and reduce dose to normal tissue. Adaptive radiotherapy (ART) is an evolving field that aims to overcome this. Improved knowledge of tumour biology and advances in imaging techniques aims to further optimise and personalise treatment.

SUBMITTER: Portner R

PROVIDER: S-EPMC8385113 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer.

Portner R R Bajaj A A Elumalai T T Huddart R R Murthy V V Nightingale H H Patel K K Sargos P P Song Y Y Hoskin P P Choudhury A A

Clinical and translational radiation oncology 20210808

Bladder preservation with trimodality treatment (TMT) is an alternative strategy to radical cystectomy (RC) for the management of localised muscle invasive bladder cancer (MIBC). TMT comprises of transurethral resection of the bladder tumour (TURBT) followed by radiotherapy with concurrent radiosensitisation. TMT studies have shown neo-adjuvant chemotherapy with cisplatin-based regimens is often given to further improve survival outcomes. A hypofractionated radiotherapy regimen is preferable due ...[more]

PMID: 34466667

Similar Datasets

Project description:BackgroundThe gold standard treatment for localized muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy with radical cystectomy (RC). Guidelines suggest concurrent chemoradiation (CRT) could be considered as an alternative, and partial cystectomy (PC) may be considered in carefully selected individuals. The bladder preservation strategies are gaining popularity, and due to the concerns about morbidity associated with RC and limited life expectancy, the octogenarian population is exploring strategies that help preserve bladder function. Hence, it is crucial to understand the outcome of various bladder preservation strategies. Using the National Cancer Database (NCDB), we compared the overall survival (OS) of octogenarians treated with PC and CRT.MethodsWe retrospectively evaluated the octogenarians with localized MIBC (cT2N0M0) ≤5 cm and urothelial histology between 2004 and 2018. Our analytic cohorts were the PC cohort, which included patients who underwent PC, and the CRT cohort, which included patients who received chemotherapy and radiotherapy within a 90-day timeframe. After propensity-matching with race and ethnicity, gender, facility type, median income, comorbidity index, and tumor grade, we compared the OS between PC and CRT cohorts.ResultsA total of 1,038 were octogenarians who met our selection criteria. Among them, 248 (23.8%) underwent PC, and 790 (76.2%) received CRT. In the PC cohort, tumors were located predominantly in the dome (34.3%) and anterior wall (10.5%), while in the CRT cohort, tumors were in the trigone (8.4%), lateral (22.0%) and posterior walls (10.6%). The median OS for the matched PC and CRT cohort was 38.3 and 32.9 months, respectively (P=0.66). Multivariate Cox regression showed no difference in survival hazards between PC and CRT [hazard ratio =1.07 (95% confidence interval: 0.82-1.39)] (P=0.63).ConclusionsOur study comparing PC and CRT in octogenarians with T2 ≤5 cm tumors showed that PC had comparable OS to CRT. Therefore, PC can be considered a viable option in carefully selected octogenarians.

Project description:BackgroundBladder preservation therapy is an alternative to radical cystectomy in patients with muscle-invasive bladder cancer (MIBC). The purpose of this study is to compare survival outcomes between bladder preservation therapy and radical cystectomy in MIBC patients using an Asian nationwide cancer registry database.MethodsFrom the Taiwan Cancer Registry database and the Taiwan National Health Insurance Research Database, we identified bladder cancer patients from 2008 to 2018. The patients with urothelial carcinoma and clinical stage T2-T4aN0-1 M0 were included. Propensity score matching by age, gender, clinical stage, cT classification, and Charlson Comorbidity Index score was used between those receiving bladder preservation therapy or radical cystectomy. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were compared using the Kaplan-Meier method. Multivariate Cox regression models were used to determine the predictive factors of OS, CSS, and DFS.ResultsFollowing the propensity score matching, 393 MIBC patients were analyzed, 131 (33.3%) receiving bladder preservation therapy and 262 (66.7%) receiving radical cystectomy. After 5 years of the follow-up period the overall duration was with a median of 15.6 months. The treatment groups did not differ significantly in OS, CSS, and DFS (p = 0.2681, 0.7208, and 0.3616, respectively). In multivariable Cox regression models, bladder preservation therapy remained non-inferior to radical cystectomy in OS (adjusted hazard ratio [aHR] 1.08; 95% confidence interval [CI], 0.77-1.50; p = 0.6689), CSS (aHR, 1.06; 95% CI, 0.72-1.57; p = 0.7728), and DFS (aHR, 0.76; 95% CI, 0.46-1.27; p = 0.2929). Additionally, among patients ≥80 years, the use of bladder preservation therapy compared with radical cystectomy resulted in an equivalent OS, CSS and DSS.ConclusionIn Asian populations, bladder preservation therapy yielded similar survival outcomes as radical cystectomy in MIBC patients. Based on the results, it is evident that a multidisciplinary approach and shared decision-making are recommended for bladder cancer treatment.

Project description:BackgroundMuscle-invasive bladder cancer (MIBC) is a rare but serious event following definitive radiation for prostate cancer. Radiation-associated MIBC (RA-MIBC) can be difficult to manage given the challenges of delivering definitive therapy to a previously irradiated pelvis. The genomic landscape of RA-MIBC and whether it is distinct from non-RA-MIBC are unknown.ObjectiveTo define mutational features of RA-MIBC and compare the genomic landscape of RA-MIBC with that of non-RA-MIBC.Design, setting, and participantsWe identified patients from our institution who received radiotherapy for prostate cancer and subsequently developed MIBC.Outcome measurements and statistical analysisWe performed whole exome sequencing of bladder tumors from RA-MIBC patients. Tumor genetic alterations including mutations, copy number alterations, and mutational signatures were identified and were compared with genetic features of non-RA-MIBC. We used the Kaplan-Meier method to estimate recurrence-free (RFS) and overall (OS) survival.Results and limitationsWe identified 19 RA-MIBC patients with available tumor tissue (n = 22 tumors) and clinical data. The median age was 76 yr, and the median time from prostate cancer radiation to RA-MIBC was 12 yr. The median RFS was 14.5 mo and the median OS was 22.0 mo. Compared with a cohort of non-RA-MIBC analyzed in parallel, there was no difference in tumor mutational burden, but RA-MIBCs had a significantly increased number of short insertions and deletions (indels) consistent with previous radiation exposure. We identified mutation signatures characteristic of APOBEC-mediated mutagenesis, aging, and homologous recombination deficiency. The frequency of mutations in many known bladder cancer genes, including TP53, KDM6A, and RB1, as well as copy number alterations such as CDKN2A loss was similar in RA-MIBC and non-RA-MIBC.ConclusionsWe identified unique mutational properties that likely contribute to the distinct biological and clinical features of RA-MIBC.Patient summaryBladder cancer is a rare but serious diagnosis following radiation for prostate cancer. We characterized genetic features of bladder tumors arising after prostate radiotherapy, and identify similarities with and differences from bladder tumors from patients without previous radiation.

Project description:Background and objectiveMuscle-invasive bladder cancer (MIBC) is a biologically aggressive disease and its prognosis is poor. Radical cystectomy (RC) with urinary diversion and lymph node dissection is the gold standard treatment for MIBC patients. Accumulating evidence indicates that sarcopenia, the degenerative and systemic loss of skeletal muscle mass, is a significant predictor of higher rates of mortality and perioperative complications following RC. Recently, bladder preservation therapy has been offered as an alternative in appropriately selected MIBC patients who desire to preserve their bladders and those unfit or unwilling for RC. Here, we performed a narrative review on the impact of sarcopenia on oncological outcomes and complication rates in MIBC patients treated with bladder preservation therapy.MethodsA literature review was performed using the PubMed and Scopus databases.Key content and findingsWe identified two studies reported the impact of sarcopenia on responses to trimodal therapy and survival outcomes in MIBC patients. Consolidative partial cystectomy was performed in patients who achieved clinical complete response (CR) to trimodal therapy in one of the two studies. In both studies, CR rates to trimodal therapy are comparable between sarcopenic and non-sarcopenic patients. Sarcopenia was not significantly associated with shorter survival after completing bladder preservation therapy in either study. For complication rates of bladder preservation therapy, one study showed equivalent complication rates of consolidative partial cystectomy between sarcopenic and non-sarcopenic patients. In addition, in another small series of trimodal therapy, sarcopenic patients showed a higher rate of complications of trimodal therapy compared with non-sarcopenic patients.ConclusionsAccording to the result of our literature review, sarcopenia would not affect responses to trimodal therapy and prognosis in MIBC patients treated with bladder preservation therapy. Although the effect of sarcopenia on complication rates of bladder preservation therapy is inconclusive due to limited evidence, bladder preservation therapy could be a viable alternative option in carefully selected MIBC patients regardless of the presence of sarcopenia.

Dataset Information

A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer.

Publications

A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets