Skip to main content
Erschienen in: Journal of Radiation Oncology 4/2017

10.07.2017 | Original Research

Maximizing survival in patients with muscle-invasive bladder cancer undergoing curative bladder-preserving radiotherapy: the impact of radiotherapy dose escalation

verfasst von: Mark Korpics, Alec M. Block, Basel Altoos, Brendan Martin, Kyle Carey, James Welsh, Matthew M. Harkenrider, Abhishek A. Solanki

Erschienen in: Journal of Radiation Oncology | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Most historic trials demonstrating the outcomes with bladder-preserving radiotherapy (RT) used 64–66 Gy. However, newer data suggest improved outcomes with dose escalation up to 70 Gy. Our objective was to explore the impact of dose escalation on overall survival (OS) and to identify the optimal radiotherapy (RT) dose in patients with muscle-invasive bladder cancer (MIBC) treated with curative bladder-preserving RT.

Methods

We conducted a retrospective cohort study of patients with cT2–4 N0–3 M0 transitional cell MIBC who were treated with curative RT (60–70 Gy in 1.8–2.0 Gy/fraction) using the National Cancer Database. Univariable (UVA) and multivariable (MVA) frailty survival analyses were employed to identify the association of dose escalation to 67–70 Gy, as well as different RT dose subgroups within 60–66 Gy, and OS.

Results

In total, 2531 patients met eligibility criteria. The 2-year OS was 53 and 56%, respectively, for patients receiving 60–66 and 67–70 Gy (p = .25). On MVA, there was no significant difference in survival for patients receiving 67–70 vs. 60–66 Gy (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.76–1.10; p = .33). Compared to doses of 64–66 Gy, OS was worse with 60–61 Gy (HR, 1.33; 95% CI, 1.17–1.52; p < .0001) but there was no difference in OS with 62–63 Gy (HR, 1.11; 95% CI, 0.96–1.28; p = .15) after adjusting for clinical T stage and Charlson-Deyo comorbidity score.

Conclusions

When treating patients with MIBC with curative bladder-preserving radiotherapy, RT doses of 62–66 Gy have improved OS compared to lower doses, while dose escalation to 67–70 Gy does not improve survival. Our study does not support deviating from the standard of 64–66 Gy.
Literatur
3.
Zurück zum Zitat Grossman HB, Natale RB, Tangen CM et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349(9):859–866. doi:10.1056/Nejmoa022148 CrossRefPubMed Grossman HB, Natale RB, Tangen CM et al (2003) Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 349(9):859–866. doi:10.​1056/​Nejmoa022148 CrossRefPubMed
5.
Zurück zum Zitat Mak RH, Hunt D, Shipley WU et al (2014) Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol 32(34):3801–3809. doi:10.1200/JCO.2014.57.5548 CrossRefPubMedPubMedCentral Mak RH, Hunt D, Shipley WU et al (2014) Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol 32(34):3801–3809. doi:10.​1200/​JCO.​2014.​57.​5548 CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Solanki AA, Martin B, Korpics M, Small C, Harkenrider MM, Mitin T (2016) Variability of radiation oncologists’ chemoradiotherapy patterns of care and the impact of multidisciplinary clinics in muscle-invasive bladder cancer. In: American Society for Radiation Oncology 58th Annual Meeting. Boston Solanki AA, Martin B, Korpics M, Small C, Harkenrider MM, Mitin T (2016) Variability of radiation oncologists’ chemoradiotherapy patterns of care and the impact of multidisciplinary clinics in muscle-invasive bladder cancer. In: American Society for Radiation Oncology 58th Annual Meeting. Boston
11.
Zurück zum Zitat Hafeez S, Warren-Oseni K, McNair HA et al (2016) Prospective study delivering simultaneous integrated high dose tumour boost (up to 70Gy) with image guided adaptive radiotherapy (IGART) for the radical treatment of localized muscle invasive bladder cancer. Int J Radiat Oncol Biol Phys 94(2016):1022–1030. doi:10.1016/j.ijrobp.2015.12.379 CrossRefPubMed Hafeez S, Warren-Oseni K, McNair HA et al (2016) Prospective study delivering simultaneous integrated high dose tumour boost (up to 70Gy) with image guided adaptive radiotherapy (IGART) for the radical treatment of localized muscle invasive bladder cancer. Int J Radiat Oncol Biol Phys 94(2016):1022–1030. doi:10.​1016/​j.​ijrobp.​2015.​12.​379 CrossRefPubMed
13.
Zurück zum Zitat Newman LA, Lee CT, Parekh LP et al (2006) Use of the National Cancer Data Base to develop clinical trials accrual targets that are appropriate for minority ethnicity patients: a report from the American College of Surgeons Oncology Group (ACOSOG) Special Population Committee. Cancer 106(1):188–195. doi:10.1002/cncr.21592 CrossRefPubMed Newman LA, Lee CT, Parekh LP et al (2006) Use of the National Cancer Data Base to develop clinical trials accrual targets that are appropriate for minority ethnicity patients: a report from the American College of Surgeons Oncology Group (ACOSOG) Special Population Committee. Cancer 106(1):188–195. doi:10.​1002/​cncr.​21592 CrossRefPubMed
15.
Zurück zum Zitat Lin DY, Wei LJ, Ying Z (1993) Checking the cox model with cumulative sums of martingale-based residuals. Biometrika 80(3):557–572CrossRef Lin DY, Wei LJ, Ying Z (1993) Checking the cox model with cumulative sums of martingale-based residuals. Biometrika 80(3):557–572CrossRef
19.
Zurück zum Zitat Perdonà S, Autorino R, Damiano R et al (2008) Bladder-sparing, combined- modality approach for muscle-invasive bladder cancer: a multi-institutional, long-term experience. Cancer 112(1):75–83. doi:10.1002/cncr.23137 CrossRefPubMed Perdonà S, Autorino R, Damiano R et al (2008) Bladder-sparing, combined- modality approach for muscle-invasive bladder cancer: a multi-institutional, long-term experience. Cancer 112(1):75–83. doi:10.​1002/​cncr.​23137 CrossRefPubMed
21.
24.
Zurück zum Zitat Søndergaard J, Høyer M, Petersen JB, Wright P, Grau C, Muren LP (2009) The normal tissue sparing obtained with simultaneous treatment of pelvic lymph nodes and bladder using intensity-modulated radiotherapy. Acta Oncol 48(2):238–244. doi:10.1080/02841860802251575 CrossRefPubMed Søndergaard J, Høyer M, Petersen JB, Wright P, Grau C, Muren LP (2009) The normal tissue sparing obtained with simultaneous treatment of pelvic lymph nodes and bladder using intensity-modulated radiotherapy. Acta Oncol 48(2):238–244. doi:10.​1080/​0284186080225157​5 CrossRefPubMed
25.
Zurück zum Zitat Søndergaard J, Holmberg M, Jakobsen AR, Agerbæk M, Muren LP, Høyer M (2014) A comparison of morbidity following conformal versus intensity-modulated radiotherapy for urinary bladder cancer. Acta Oncol 53(10):1321–1328. doi:10.3109/0284186X.2014.928418 CrossRefPubMed Søndergaard J, Holmberg M, Jakobsen AR, Agerbæk M, Muren LP, Høyer M (2014) A comparison of morbidity following conformal versus intensity-modulated radiotherapy for urinary bladder cancer. Acta Oncol 53(10):1321–1328. doi:10.​3109/​0284186X.​2014.​928418 CrossRefPubMed
Metadaten
Titel
Maximizing survival in patients with muscle-invasive bladder cancer undergoing curative bladder-preserving radiotherapy: the impact of radiotherapy dose escalation
verfasst von
Mark Korpics
Alec M. Block
Basel Altoos
Brendan Martin
Kyle Carey
James Welsh
Matthew M. Harkenrider
Abhishek A. Solanki
Publikationsdatum
10.07.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Radiation Oncology / Ausgabe 4/2017
Print ISSN: 1948-7894
Elektronische ISSN: 1948-7908
DOI
https://doi.org/10.1007/s13566-017-0319-2

Weitere Artikel der Ausgabe 4/2017

Journal of Radiation Oncology 4/2017 Zur Ausgabe

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

25.04.2024 NSCLC Nachrichten

Das Risiko für Rezidiv oder Tod von Patienten und Patientinnen mit reseziertem ALK-positivem NSCLC ist unter einer adjuvanten Therapie mit dem Tyrosinkinase-Inhibitor Alectinib signifikant geringer als unter platinbasierter Chemotherapie.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

ICI-Therapie in der Schwangerschaft wird gut toleriert

Müssen sich Schwangere einer Krebstherapie unterziehen, rufen Immuncheckpointinhibitoren offenbar nicht mehr unerwünschte Wirkungen hervor als andere Mittel gegen Krebs.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.