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Purpose/Objectives: The main purpose of this study was to report treatment outcomes of definitive image-guided accelerated hypofractionated radiation therapy for elderly patients with muscle-invasive bladder cancer unsuitable for surgery or trimodality therapy. Materials and Methods: Patients with confirmed muscle-invasive or high-risk T1 transitional cell carcinoma of the bladder, stage T1-T4aN0M0, who underwent transurethral resection of bladder tumor were irradiated with 45 Gy in 15 fractions. Comorbidity was assessed by Charlson Comorbidity Index. Cystoscopy, cytology, and computerised tomography imaging were used to evaluate treatment outcomes. Results: Seventeen patients with a median age of 87 (range, 81 to 95) years and age-adjusted Charlson Comorbidity Index ≥3 were included. Transurethral resection of bladder tumor was incomplete in 65%. Radiation technique evolved from 3-dimensional conformal radiotherapy (3D CRT, 47%) to volumetric modulated arc therapy (VMAT, 53%). Ninety-four percent completed radiotherapy, with a median time of 20 days. The median follow-up was 65.3 months. Complete local response at 3-month cystoscopy was 69%. Six patients developed a local recurrence (35%), and 2 patients developed distant metastases (11.7%). Overall survival at 1 year was 47% and 23% at 2 years. Cancer-specific survival at 1 and 2 years were 85% and 63%, respectively. Acute grade 3 gastrointestinal or genitourinary toxicities were 6% and 24%, respectively. No grade 4 toxicity was documented. Diarrhea of any grade occurred in 35% of patients treated with 3D CRT, but in none of the patients treated with VMAT (P=0.002). Conclusions: Accelerated hypofractionated radiotherapy alone provides good local control in elderly patients unfit for chemoradiotherapy. Contemporary radiation techniques such as VMAT were associated with reduced bowel toxicity compared with 3D CRT.

Following traumatic brain injury, there is no restoration of the lost nervous tissue, mainly due to the formation of a scar. One promising strategy to overcome this hurdle is grafting scaffolds that can disturb the scar blockade, enabling cell invasion into the wound. The aragonite skeleton of corals is useful scaffolds for testing this strategy, being supportive for neural cells in culture. The purpose of this work was to check if a contact between a coralline scaffold and an injured nervous tissue affects scar formation and if this effect can be regulated by engineering the scaffold's surface topology. To address that, hippocampal slices were cultivated on a coral skeleton having two distinct surface shapes: (1) intact skeleton pieces (ISP): porous, microrough surface; (2) grained skeleton (GS): nonporous, macrorough surface. On ISP, slices deformed by engulfing the scaffold's outer surface without penetrating the pores, yet, they preserved their coherence. By contrast, on GS slices were flat, but broken into interconnected small segments of tissue. In addition, whereas on ISP astrocytes were significantly more active and diffusely distributed, on GS reactive astrocytes tightened into a single <90 μm wide scar-like stripe at the slice's periphery. Hence, by grafting coralline scaffolds of predesigned surface roughness and porosity into brain wounds, control over scar tissue formation can be gained, providing an opportunity for cell migration and damage repair. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2295-2306, 2018.

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The aim was to determine the efficacy, safety, and tolerability of weekly ultra hypofractionated radiation therapy for older unfit patients with invasive bladder cancer. Methods:We retrospectively analyzed a cohort of patients with muscle invasive bladder cancer deemed unfit for chemoradiation therapy and thus treated with 6 weekly doses of 6 Gy using intensity modulated radiotherapy. Charlson comorbidity was calculated retrospectively. Cystoscopy and computed tomography were used to evaluate local control and toxicity using the common terminology criteria. Survival outcomes were estimated using the Kaplan-Meier method.Results: Twenty-two patients with a median age of 84 (range: 70 to 96) years were included. The median comorbidity index was 6 1.5 SD. Nineteen (90%) patients received the full 36 Gy dose. Median follow-up was 10 7 months (range: 6 to 27 mo). Local control in the bladder was achieved in 16 of 19 evaluable patients (84%). One-year overall survival was 62.5%, 1 patient had a retroperitoneal nodal recurrence and 3 patients developed distant metastasis. Grade 3 genitourinary and gastrointestinal toxicity was observed in 4 (18%) and 1 (4.5%) patients, respectively. Conclusion:Weekly ultra hypofractionated intensity modulated radiotherapy with image guidance and bladder training is an effective, safe, and well-tolerated regimen for older patients with invasive bladder cancer unfit for radical treatment.

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