Postoperative radiotherapy of carcinoma in bilharzial bladder using a three-fractions per day regimen

Zaghloul, Mohammed; Awwad, Hassan K.; Soliman, Omar S.; Omar, Sherif; Badawy, Samy El; Barsoum, Mohsen Samy; Mocktar, Nadia; Amer, Fatima Al

doi:10.1016/s0167-8140(86)80192-x

Cited by 23 publications

(12 citation statements)

References 19 publications

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“…However, the role of PORT in bladder cancer is still controversial in many Western publications compared with in Egyptian ones. 1 – 8 In our cohort, patients treated with PORT had the worst clinicopathological features. The most common argument against the use of PORT is the radiation-induced complications, especially the late small bowel complications, as seen in our study (8% of cases had small bowel obstruction).…”

Section: Discussionmentioning

confidence: 86%

“…However, retrospective data regarding PORT are insufficient, and only one prospective study that tested PORT showed improvement in disease-free survival (DFS) without any improvement in overall survival (OS). 6 – 8 The radiation-induced late complications are the main limiting factor for the use of PORT after RC worldwide; however, the risk for radiation-induced complications can be minimized by novel radiotherapy techniques (conformal radiotherapy or intensity-modulated radiotherapy). 4 …”

Section: Introductionmentioning

confidence: 99%

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Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients

Bayoumi¹,

Heikal²,

Darweish³

2014

CMAR

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Background:Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard treatment for muscle-invasive bladder cancers. However, the locoregional recurrence rate is still significantly higher for locally advanced cases post-RC. The underuse of postoperative radiotherapy (PORT) in such cases after RC is related mainly to a lack of proven survival benefit. Here we are reporting our long-term Egyptian experience with bladder cancer patients treated with up-front RC with or without conformal PORT.Patients and methods:This retrospective study included 170 locally advanced bladder cancer (T3–T4, N0/N1, M0) patients who had RC performed with or without PORT at Damietta Cancer Institute during the period of 1998–2006. The treatment outcomes and toxicity profile of PORT were evaluated and compared with those of a non-PORT group of patients.Results:Ninety-two patients received PORT; 78 did not. At median follow-up of 47 months (range, 17–77 months), 33% locoregional recurrences were seen in the PORT group versus 55% in the non-PORT group (P<0.001). The overall distant metastasis rate in the whole group was 39%, with no difference between the two groups. The 5-year disease-free survival for the whole group of patients was 53%±11%, which was significantly affected by additional PORT, and 65%±13% compared with 40%±9% for the non-PORT group (P=0.04). The pathological subtypes did not affect 5-year disease-free survival significantly (P=0.9). The 5-year overall survival was 44%±10%. Using multivariate analysis, PORT, stage, and extravesical extension (positive surgical margins) were found to be important prognostic factors for locoregional control. Stage and lymph node status were important prognosticators for distant metastasis control.Conclusion:PORT was found to be a safe and effective tool in decreasing local recurrence rates and improving disease-free survival.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients

Bayoumi¹,

Heikal²,

Darweish³

2014

CMAR

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“…Despite these promising results, the approach was abandoned due to a significant rate of toxicities related to RT technique. In older studies [6, 14, 16, 17], the doses received by the rectum, the femoral heads, and especially the small intestine generated acute toxicities grade > 2. Recently, the development of 3DCRT, IMRT and imaging-guided radiation therapy (IGRT) has improved definition of CTVs and enabled sparing of adjacent organs-at-risk.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study

et al. 2017

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ObjectivesRadical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC.Material and methodsWe retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale.ResultsBetween 2000 and 2013, 57 patients [median age 66.3 years (45–84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2–33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4–50). A boost of 16 Gy (5–22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30–60), 37% (95%CI 24–51) and 49% (95%CI 33–63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context.ConclusionsBecause of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.

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“…Zaghloul et al ont démontré dans un essai prospectif randomisé l'intérêt de la radiothérapie postopératoire par rapport à une simple surveillance [43,44]. Dans le bras radiothérapie postopératoire, la SSR à cinq ans était de 44 % en fractionnement conventionnel (FC) [50 Gy en 25 fractions quotidiennes de 2 Gy étalées sur cinq semaines], de 49 % en hyperfractionnement (HF) [37,5 Gy en trois fractions quotidiennes de 1,25 Gy espacées de trois heures chacune étalées sur 12 jours].…”

Section: Résultats Des éTudes De Radiothérapie Postopératoireunclassified

Radiothérapie périopératoire dans la prise en charge des tumeurs urothéliales infiltrantes de la vessie (TVIM) : une indication à reconsidérer ?

et al. 2015

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Postoperative radiotherapy of carcinoma in bilharzial bladder using a three-fractions per day regimen

Cited by 23 publications

References 19 publications

Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients

Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients

Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study

Radiothérapie périopératoire dans la prise en charge des tumeurs urothéliales infiltrantes de la vessie (TVIM) : une indication à reconsidérer ?

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