Metastasis-Directed Radiation Therapy with Consolidative Intent for Oligometastatic Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Abstract

The management of patients with oligometastatic urothelial carcinoma (UC) represents an evolving field in uro-oncology, and the role of metastasis-directed therapies, including metastasectomy and metastasis-directed radiation therapy (MDRT), is gaining increasing attention. Herein, we summarize available evidence about the role of MDRT with consolidative intent in oligometastatic UC patients. A systematic review was performed in December 2021. Six studies involving 158 patients were identified. Most patients (n = 120, 90.2%) had a history of bladder cancer and the most frequent sites of metastases were lymph nodes (n= 61, 52.1%) followed by the lungs (n = 34, 29%). Overall, 144 metastases were treated with MDRT. Median follow-up ranged from 17.2 to 25 months. Local control rates ranged from 57% to 100%. Median Overall Survival (OS) ranged from 14.9 to 51.0 months and median progression-free survival ranged from 2.9 to 10.1 months. Rates of OS at one and two years ranged from 78.9% to 96% and from 26% to 63%, respectively. Treatment-related toxicity was recorded in few patients and in most cases a low-grade toxicity was evident. MDRT with consolidative intent represents a potential treatment option for selected patients with oligometastatic UC.

Definitions, outcomes and perspectives for oligometastatic bladder cancer: towards a standardized terminology

“…Longo et al . [40 ▪ ] have performed a systematic review and a meta-analysis on six retrospective studies including radiotherapy-based MDT, performed mainly in the oligorecurrent setting (nodal, 52%, lung, 32%) with previous radical surgery; they reported local control rates (i.e. response or stability of the treated lesions) from 57 to 100%, with minimal morbidity.…”

“…response or stability of the treated lesions) from 57 to 100%, with minimal morbidity. Median OS, ranging from 12 to 54 months, could at least partly reflect a patient selection bias [40 ▪ ]. Prospective evidence in this field is embryonic, with a phase I trial of stereotactic radiotherapy with sequential or concomitant pembrolizumab [41].…”

Could we safely omit a Repeat Transurethral Resection of the Bladder (re-TURB) after Hexaminolevulinate Photodynamic Diagnostics (PDD)-TURB?

“…Transurethral resection of the bladder (TURB) is considered the gold standard to ascertain BC diagnosis, and plan further treatments and can be a curative procedure for early-stage disease (pTa/T1 tumours) (3)(4)(5). Nonetheless, guidelines also recommend performing a second TURB in specific clinical scenarios, mainly: after an incomplete first TURB, when there are doubts about the completeness of the first resection, in case of the absence of detrusor muscle in the specimen (except for Ta LG/G1 tumours and primary CIS) and when there is the presence of T1 tumours (6,7). Second TURB (reTURB) has the intent to eradicate all the tumour burden since there is a consistent risk of leaving residual tumours and consequently of recurrence (1,8,9).…”