- Email: [email protected]
Radical Radiotherapy for Bladder Cancer — Contemporary Outcomes from a UK Centre
240
Letters / Clinical Oncology 26 (2014) 236e240 Institute: Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events, Version 3.0 http://ctep.
cancer.gov/protocolDevelopment/electronic_applications/ docs/ctcaev3.pdf [accessed 30.11.09]
Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved http://dx.doi.org/10.1016/j.clon.2014.01.005
Radical Radiotherapy for Bladder Cancer d Contemporary Outcomes from a UK Centre Sir d It is suggested that the optimal treatment for muscle invasive bladder cancer (MIBC) is platinum-based neoadjuvant chemotherapy followed by radical surgery [1]. There is increasing evidence suggesting equivalent survival rates for TURBT, chemotherapy and radiotherapy. Two recent UK studies investigating concurrent chemotherapy [2] or carbogen and nicotinamide [3] have both shown gains in efficacy with a concurrent strategy, but also rates of disease-free and overall survival that are comparable with the best reported surgical outcomes. We undertook a retrospective audit, looking at overall survival for all patients treated with radical radiotherapy for MIBC at the Sussex Cancer Centre between January 2005 and December 2010. In total, 136 patients were identified, of whom 112 had records available for analysis. Treatment was computed tomography planned with three-dimensional conformal radiotherapy. All patients received a radiobiologically equivalent dose to 64 Gy in 32 fractions. Forty-four per cent of patients received neoadjuvant chemotherapy (three to five cycles of gemcitabine and cisplatin). Ninetythree per cent of patients completed their assigned treatment. Data were analysed using SPSS 19.0. Parametric and non-parametric continuous variables were analysed using Student’s t-test and ManneWhitney U test, respectively. Categorical variables were analysed using the chi-squared test. The mean overall survival was 49 months. The overall survival rate at 60 months was 63% for the whole group. There was no statistical difference in overall survival in terms of age at presentation. Correlation was noted between comorbidities and survival. However, statistical testing was not possible as proportional hazard assumption was not met. Current international survival outcomes for bladdersparing treatment of MIBC stand at 50e70% for 5 year overall survival [4e6]. In our population-based, non-trial cohort we have shown survival outcomes that are
consistent with published data from randomised controlled trials. Current 5 year survival outcomes for surgical treatment of MIBC stand at 45e77% [7,8]. Our data support the growing body of evidence that trimodal therapy is a viable alternative to radical cystectomy in the treatment of MIBC. C.F.K. Lorimer, J. Adam, K.H.J. Lim, A. Nikapota Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
References [1] Stenzl A, Cowan NC, De Santis M. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 2011;59(6):1009e1018. [2] James N, Hussain S, Hall E. A 2x2 phase III randomised trial of synchronous chemo-radiotherapy (CRT) compared to radiotherapy (RT) alone and standard (sRT) versus reduced highdose volume RT (rvRT) in muscle invasive bladder cancer (MIBC). J Clin Oncol 2010;28:15s:(suppl; abstract 4517). [3] Hoskin PJ, Rojas AM, Bentzen SM. Radiotherapy with concurrent carbogen and nicotinamide in bladder carcinoma. J Clin Oncol 2010;28(33):4912e4918. € del C, Weiss C, Sauer R. Trimodality treatment and selective [4] Ro organ preservation for bladder cancer. J Clin Oncol 2006; 24(35):5536e5544. [5] Koga F, Kihara K. Selective bladder preservation with curative intent for muscle-invasive bladder cancer: a contemporary review. Int J Urol 2012;19(5):388e401. [6] Kotwal S, Choudhury A, Johnston C. Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom specialist treatment center. Int J Radiat Oncol Bio Phys 2008;70(2): 456e463. [7] Madersbacher S, Hochreiter W, Burkhard F. Radical cystectomy for bladder cancer today: a homogeneous series without neoadjuvant therapy. J Clin Oncol 2003;21:690e696. [8] Hautmann RE, de Petriconi RC, Pfeiffer C. Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol 2012;61(5):1039e1047.
Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved http://dx.doi.org/10.1016/j.clon.2014.01.007
Letters / Clinical Oncology 26 (2014) 236e240 Institute: Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events, Version 3.0 http://ctep.
cancer.gov/protocolDevelopment/electronic_applications/ docs/ctcaev3.pdf [accessed 30.11.09]
Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved http://dx.doi.org/10.1016/j.clon.2014.01.005
Radical Radiotherapy for Bladder Cancer d Contemporary Outcomes from a UK Centre Sir d It is suggested that the optimal treatment for muscle invasive bladder cancer (MIBC) is platinum-based neoadjuvant chemotherapy followed by radical surgery [1]. There is increasing evidence suggesting equivalent survival rates for TURBT, chemotherapy and radiotherapy. Two recent UK studies investigating concurrent chemotherapy [2] or carbogen and nicotinamide [3] have both shown gains in efficacy with a concurrent strategy, but also rates of disease-free and overall survival that are comparable with the best reported surgical outcomes. We undertook a retrospective audit, looking at overall survival for all patients treated with radical radiotherapy for MIBC at the Sussex Cancer Centre between January 2005 and December 2010. In total, 136 patients were identified, of whom 112 had records available for analysis. Treatment was computed tomography planned with three-dimensional conformal radiotherapy. All patients received a radiobiologically equivalent dose to 64 Gy in 32 fractions. Forty-four per cent of patients received neoadjuvant chemotherapy (three to five cycles of gemcitabine and cisplatin). Ninetythree per cent of patients completed their assigned treatment. Data were analysed using SPSS 19.0. Parametric and non-parametric continuous variables were analysed using Student’s t-test and ManneWhitney U test, respectively. Categorical variables were analysed using the chi-squared test. The mean overall survival was 49 months. The overall survival rate at 60 months was 63% for the whole group. There was no statistical difference in overall survival in terms of age at presentation. Correlation was noted between comorbidities and survival. However, statistical testing was not possible as proportional hazard assumption was not met. Current international survival outcomes for bladdersparing treatment of MIBC stand at 50e70% for 5 year overall survival [4e6]. In our population-based, non-trial cohort we have shown survival outcomes that are
consistent with published data from randomised controlled trials. Current 5 year survival outcomes for surgical treatment of MIBC stand at 45e77% [7,8]. Our data support the growing body of evidence that trimodal therapy is a viable alternative to radical cystectomy in the treatment of MIBC. C.F.K. Lorimer, J. Adam, K.H.J. Lim, A. Nikapota Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
References [1] Stenzl A, Cowan NC, De Santis M. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 2011;59(6):1009e1018. [2] James N, Hussain S, Hall E. A 2x2 phase III randomised trial of synchronous chemo-radiotherapy (CRT) compared to radiotherapy (RT) alone and standard (sRT) versus reduced highdose volume RT (rvRT) in muscle invasive bladder cancer (MIBC). J Clin Oncol 2010;28:15s:(suppl; abstract 4517). [3] Hoskin PJ, Rojas AM, Bentzen SM. Radiotherapy with concurrent carbogen and nicotinamide in bladder carcinoma. J Clin Oncol 2010;28(33):4912e4918. € del C, Weiss C, Sauer R. Trimodality treatment and selective [4] Ro organ preservation for bladder cancer. J Clin Oncol 2006; 24(35):5536e5544. [5] Koga F, Kihara K. Selective bladder preservation with curative intent for muscle-invasive bladder cancer: a contemporary review. Int J Urol 2012;19(5):388e401. [6] Kotwal S, Choudhury A, Johnston C. Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom specialist treatment center. Int J Radiat Oncol Bio Phys 2008;70(2): 456e463. [7] Madersbacher S, Hochreiter W, Burkhard F. Radical cystectomy for bladder cancer today: a homogeneous series without neoadjuvant therapy. J Clin Oncol 2003;21:690e696. [8] Hautmann RE, de Petriconi RC, Pfeiffer C. Radical cystectomy for urothelial carcinoma of the bladder without neoadjuvant or adjuvant therapy: long-term results in 1100 patients. Eur Urol 2012;61(5):1039e1047.
Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved http://dx.doi.org/10.1016/j.clon.2014.01.007