Efficacy of Palliative Bladder Radiotherapy for Hematuria in Advanced Bladder Cancer Using Contemporary Radiotherapy Techniques

Tey, Jeremy; Soon, Yu Yang; Cheo, Timothy; Ooi, Kiat Huat; Ho, Francis; Vellayappan, Balamurugan; Chia, David; Tai, Bee Choo

doi:10.21873/invivo.11718

Cited by 14 publications

(16 citation statements)

References 20 publications

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“…Immediately following the completion of the radiotherapy regime over half of these patients experienced improvement in their haematuria with worsening symptoms were seen in less than 10%. The rapid onset (within days to weeks) of haematuria relief has been confirmed by several other retrospective studies (15,16).…”

Section: Radiotherapy Outcomes For Specific Bladder Symptomssupporting

confidence: 56%

The role of palliative radiotherapy in bladder cancer: a narrative review

Raby

Hoskin

Choudhury³

2020

Ann Palliat Med

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Bladder cancer is the 6 th most common cancer worldwide and contributes significant excess mortality and morbidity. It often presents at a late stage when it is incurable, and the prognosis is poor.The local symptoms of bladder cancer-including haematuria, dysuria, frequency, nocturia and pain, have significant effects on quality of life and may require frequent inpatient admissions. As a palliative treatment, radiotherapy can be uniquely useful in providing targeted long term symptomatic control, although this must be balanced against the potential of causing toxicity. A variety of radiotherapy protocols have been developed for managing these symptoms. The results of several studies show that radiotherapy delivered in a hypofractionated regime (21 Gy in 3 fractions) can provide relief of these symptoms within a few weeks.Other commonly used regimes include 35 Gy in 10 fractions, 30 Gy in 5 fractions, a once weekly 36 Gy in 6 fractions, and a single 8 Gy fraction. In the palliative setting symptom resolution lasts for the majority of the patients remaining lifespan. Benefit is particularly clear for symptomatic haematuria and in these patients even single doses may provide rapid benefit. To maximise benefit from radiotherapy, studies are urgently needed to better estimate the prognosis of patients presenting with bladder cancer.

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Section: Radiotherapy Outcomes For Specific Bladder Symptomssupporting

confidence: 56%

The role of palliative radiotherapy in bladder cancer: a narrative review

Raby

Hoskin

Choudhury³

2020

Ann Palliat Med

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“…Hemostatic radiotherapy has been reported to be an alternative option for hematuria related to bladder cancer (2,3). However, palliative radiation therapy requires multiple sessions over several days and is thus not feasible for cases of acute bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Although open surgical ligation of the internal iliac artery (IIA) or salvage cystectomy can be used as a final treatment choice, most patients are at high risk for surgery due to advanced disease and poor general condition. Palliative radiotherapy is an option for hematuria related to advanced bladder cancer (2). However, there is an insecurity about the optimal dose due to the several organs at risk in the vicinity such as small bowel and rectum (3).…”

Section: Introductionmentioning

confidence: 99%

Superselective vesical artery embolization for intractable bladder hemorrhage related to pelvic malignancy

et al. 2020

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Background Intractable bladder hemorrhage from pelvic malignancy can be potentially life-threatening and its management can be a challenging clinical problem. Purpose To evaluate safety, efficacy, and clinical outcome of superselective vesical artery embolization for the control of intractable bladder hemorrhage from pelvic malignancy. Material and Methods Between January 2010 and September 2018, 20 patients underwent superselective vesical artery embolization for intractable hematuria secondary to pelvic malignancy arising from or invading the bladder. Treatment details and clinical outcomes were obtained. Results There were 12 men and 8 women (mean age = 77 years). Bilateral embolization was performed in 10 patients and unilateral approach in 10 patients. Two patients died within four days after embolization due to underlying heart failure and systemic metastasis, respectively. The remaining 18 patients had a follow-up of >30 days. Bleeding was controlled after the first embolization in 17/18 patients and after a repeat embolization in the remaining one patient. The mean follow-up period of 18 patients was 10.6 months (range = 1–77 months). Late recurrent hemorrhage (≥ 30 days after embolization) was reported in 6 (33.3%) patients. Five of these six patients underwent repeat embolization. There were no major complications related to embolization. Conclusion Palliative superselective vesical artery embolization is a feasible, effective, and safe procedure to control intractable hematuria in patients with pelvic malignancy.

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“…Palliative radiotherapy has evolved into a highly individualized treatment concept, which provides symptom palliation and, in selected patients, improves overall survival (1,6,18,19). However, the management of patients with reduced PS (ECOG 3-4) is among several unsolved problems.…”

Section: Discussionmentioning

confidence: 99%

Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy

Nieder

Kämpe

2020

In Vivo

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Background/Aim: Previous research has suggested that palliative radiotherapy is a useful measure, unless short survival reduces the time spent without active treatment, and in the case of a low likelihood of experiencing a net benefit in quality of life. Patients with reduced performance status (PS) may be especially at risk of futile treatment, despite having a relatively high symptom burden and thus a potential benefit. Therefore, we analyzed the symptom burden of patients with Eastern Cooperative Oncology Group (ECOG) PS 3-4 in our center. Patients and Methods: A retrospective study was performed of 102 consecutive patients who received palliative radiotherapy for different indications. The Edmonton Symptom Assessment Scale (ESAS) was employed to assess the pre-radiotherapy symptoms. Results: When applying the lowest threshold (ESAS ≥1), up to 97% of patients with PS 3-4 reported symptoms, such as fatigue and dry mouth. When focusing on moderate/severe symptoms (ESAS ≥4), still up to 77% of patients with PS 3-4 reported such a burden. The largest differences between patients with PS 3-4 and those with 0-1 were seen with regard to nausea, fatigue, dry mouth and reduced appetite. The median survival of patients with PS 3-4 was 2 months. Conclusion: Given that many of the symptoms reported by patients with PS 3-4 tend to worsen temporarily after radiotherapy, patients with short survival may not experience a net benefit during the few weeks before death. However, if other symptoms such as dyspnea or pain prevail, short-course radiotherapy may result in worthwhile palliation and should, therefore, be considered on a case-bycase basis and after estimation of the remaining lifespan. 735

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Efficacy of Palliative Bladder Radiotherapy for Hematuria in Advanced Bladder Cancer Using Contemporary Radiotherapy Techniques

Cited by 14 publications

References 20 publications

The role of palliative radiotherapy in bladder cancer: a narrative review

The role of palliative radiotherapy in bladder cancer: a narrative review

Superselective vesical artery embolization for intractable bladder hemorrhage related to pelvic malignancy

Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy

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