Postoperative radiotherapy of carcinoma in bilharzial bladder: Improved disease free survival through improving local control

Zaghloul, Mohamed S.; Awwad, Hassan K.; Akoush, H.; Omar, Sherif; Soliman, Omar S.; Attar, Inas El

doi:10.1016/0360-3016(92)90005-3

Cited by 118 publications

(41 citation statements)

References 14 publications

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“…Outcomes after adjuvant pelvic RT have been evaluated in a randomized trial with 236 patients with locally advanced bladder cancers, with only 20% of urothelial carcinomas [6]. Two different adjuvant RT schedules (conventional fractionation of 50 Gy in 2 Gy per fraction and hyper-fractionation of 37.5 Gy in 3 daily fractions of 1.25 Gy spaced every three hours), compared with cystectomy alone showed that adjuvant RT reduced pelvic failures (10%-13% vs. 50%, respectively for hyperfractionated and conventionally fractionated schedules).…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…In the 1980’s, peri-operative radiotherapy (RT) was explored, demonstrating benefits in terms of loco-regional control, but associated with significant gastro-intestinal (GI) toxicity. This toxicity, directly dependent on the RT techniques used at the time has limited the development of this approach [6]. The aim of this study is to provide up-to-date estimations of outcomes and toxicity for patients treated by RC and adjuvant RT for MIBC in terms of 3-year LRR-free survival (LRRFS), MFS and OS.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…Adjuvant EBRT also has the advantage of dealing with microscopic cells along with a better identification of patients who are really at increased risk of developing local recurrence based on histological information of the primary tumor. Already two decennia ago, adjuvant EBRT was tested in a prospective randomized trial and resulted in a 20% increase in 5-year disease free survival (DFS) [19, 20]. These results were supported by a non-randomized controlled Radiation Therapy Oncology Group trial [21].…”

Section: Introductionmentioning

confidence: 99%

“…Shariat et al found that, although a limited number of patients, adjuvant radiotherapy was independently associated with lower disease recurrence (HR: 3.3, 95% CI: 2.2–4.9; p < 0.001) and improved disease specific survival (HR: 2.4, 95% CI: 1.6–3.7; p < 0.001) while in the same study the impact of adjuvant chemotherapy on similar outcomes was less clear [6]. Despite those encouraging results, severe intestinal toxicity rates hampered the enthusiasm to use adjuvant EBRT, in fact till now [19, 21]. However, the technology that was used in the above-mentioned trials is outdated and conclusions concerning toxicity do not apply to the current technologies such as intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) and image guided radiotherapy [22–24].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiotherapy after radical cystectomy for patients with muscle invasive bladder cancer: a phase II trial

et al. 2017

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BackgroundNeo-adjuvant chemotherapy followed by radical cystectomy with extended pelvic lymph node dissection is considered to be the treatment of choice for patients with muscle invasive bladder cancer (MIBC). Despite this aggressive treatment the outcome is poor and ultimately, 30% of the patients with ≥pT3 tumors develop a pelvic recurrence. We hypothesize that postoperative adjuvant external beam radiotherapy (EBRT) might prevent local and lymph node recurrence and improve disease free- and overall survival as loco-regional recurrence is linked to the development of distant metastasis.MethodsWe plan to perform a multicentric prospective phase two study including 76 patients. Eligible patients are patients with MIBC, treated with radical cystectomy and presenting with ≥1 of the following characteristics:Pathological (p)T3 stage + presence of lymphovascular invasion on pathological examinationpT4 stage<10 lymph nodes removedpositive lymph nodespositive surgical margins Patients will have a 18F–FDG PET-CT to rule out the presence of distant metastasis prior to EBRT. A median dose of 50 Gy in 25 fractions is prescribed to the pelvic lymph node regions with inclusion of the operative bladder bed in case of a positive surgical margin. Patients with suspected lymph nodes on PET- CT can still be included in the trial, but a simultaneous integrated boost to 74Gy to the positive lymph nodes will be delivered. Blood and urine samples will be collected on day-1 and last day of EBRT for evaluation of biomarkers. The primary endpoint is evaluation of acute ≥Grade 3 intestinal or grade 4 urinary toxicity, in case of a neo-bladder reconstruction, within 12 weeks after EBRT. Secondary endpoints are: assessment of QOL, late RTOG toxicity, local control, disease free survival and overall survival. Biomarkers in urine and blood will be correlated with secondary survival endpoints.DiscussionThis is a prospective phase 2 trial re-assessing the feasibility of adjuvant radiotherapy in high-risk MIBC.Trial registrationThe Ethics committee of the Ghent University Hospital (EC2014/0630) approved this study on 31/07/2014.Trial registration on Clinicaltrials.gov (NCT02397434) on November 19, 2014.

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Adjuvant Sandwich Chemotherapy Plus Radiotherapy vs Adjuvant Chemotherapy Alone for Locally Advanced Bladder Cancer After Radical Cystectomy

et al. 2018

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Postoperative radiotherapy of carcinoma in bilharzial bladder: Improved disease free survival through improving local control

Cited by 118 publications

References 14 publications

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

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

Adjuvant radiotherapy after radical cystectomy for patients with muscle invasive bladder cancer: a phase II trial

Adjuvant Sandwich Chemotherapy Plus Radiotherapy vs Adjuvant Chemotherapy Alone for Locally Advanced Bladder Cancer After Radical Cystectomy

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