Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder

Abstract

Abstract. Background A considerable number of patients with carcinoma of the urinary bladder are treated with an organ-preserving approach, mostly consisting of transurethral resection of the bladder tumour (TURBT) followed by irradiation with or without concurrent chemotherapy (1-3). Since many of these patients present with significant comorbidities, a personalised treatment program is often required. Such a program should ideally consider several patient-related factors, including the patient's social situation, patient treatment preference, additional diseases, general condition and remaining life-span. It has been reported for other situations of patients with carcinoma of the urinary bladder, such as metastatic or recurrent disease, that those patients with a poor survival prognosis should receive shorter-course and less aggressive treatments, since low treatment-related toxicity not impairing the patient's quality of life is very important for this group (4-7). Those patients with a much better prognosis should benefit from more aggressive longer-course treatments including systemic therapies leading to better control of the malignant disease and significant prolongation of the patient's survival time.In order to tailor the treatment regimen to the patient's individual situation, the ability to estimate their survival time is desirable. This goal could be achieved with a clear understanding of the independent predictors of survival identified specifically for patients with carcinoma of the urinary bladder. This study aimed to identify such predictors in a cohort of patients who received organ-preserving treatment including local irradiation. Patients and MethodsThis retrospective study included 61 patients treated with definitive irradiation for carcinoma of the urinary bladder cancer. Irradiation was performed as computed tomography-based conformal radiotherapy with 6-18 MV photons. The median dose was 59.4 Gy (range=50.4 to 63.0 Gy), which was delivered with conventional fractionation of 1.8 to 2.0 Gy on five consecutive days per week. In two-thirds of the patients (N=40), the total dose was 59.4 Gy given with 1.8 Gy per fraction. In 45 patients, irradiation was supplemented with simultaneous chemotherapy, which was mainly cisplatin-or carboplatin-based (N=27). The characteristics of the 61 patients are summarized in Table I. For the 61 patients, a total of 11 potential predictive factors were analysed with respect to an association with overall survival. These factors were gender, age (≤77 vs. >77 years; median age=77 years), T-stage (T1-2 vs. T>2a vs. T3-4), N-stage (N0 vs. N1/2), histological grading (G2 vs. G3), pack years smoked prior to irradiation (<40 vs. ≥40 years), smoking during irradiation (no vs. yes), transurethral resection of the bladder tumour prior to irradiation (TURBT; no vs. 741

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