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Coen JJ, Rodgers JP, Saylor PJ, Lee CT, Wu CL, Parker W, Lautenschlaeger T, Zietman AL, Efstathiou J, Jani AB, Kucuk O, Souhami L, Pugh SL, Sandler HM, Shipley WU. Long-Term Results of Bladder Preservation With Twice-Daily Radiation Plus 5-Fluorouracil/Cisplatin or Daily Radiation Plus Gemcitabine for Muscle-Invasive Bladder Cancer-Updated Report of NRG/RTOG 0712: A Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03230-9. [PMID: 39147209 DOI: 10.1016/j.ijrobp.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 07/15/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE For bladder-sparing treatment of muscle-invasive bladder cancer, 5-fluorouracil/cisplatin with twice-daily radiation (FCT) or gemcitabine plus daily radiation (GD) are effective chemoradiation (CRT) regimens. This trial evaluated these regimens and demonstrated efficacy with either regimen at 3 years. With further follow-up, longer-term results are reported here. METHODS AND MATERIALS Patients with cT2 to cT4a muscle-invasive bladder cancer were randomized to FCT or GD. Patients had a transurethral resection and induction CRT to 40 Gy. Patients with a complete response received consolidation CRT to 64 Gy. Others had cystectomy. Adjuvant gemcitabine/cisplatin chemotherapy was administered. The primary endpoint was freedom from distant metastasis (FDM). This updated analysis reports 7-year data. Toxicity and efficacy endpoints, including bladder-intact distant metastasis-free survival (BI-DMFS) were also assessed. RESULTS From December 2008 to April 2014, 70 patients were enrolled; 66 were eligible for analysis, 33 per arm. Median follow-up was 9.1 years for eligible living patients. At 7 years, FDM was 65% and 73% for FCT and GD, respectively. Bladder-intact distant metastasis-free survival was 58% (95% CI, 41-76) and 68% (95% CI, 51-84), respectively. The post hoc hazard ratio of 0.75 (95% CI, 0.37-1.55) showed no difference between treatments (P = .44). Overall survival at 7 years was 48% and 59%. There were 4 and 5 cystectomies performed for FCT and GD, respectively. In the FCT arm, there were 5 (16%), 1 (3%), and 0 grade 3, 4, and 5 late toxicities reported, respectively. In the GD arm, there were 7 (23%), 0, and 0 grade 3, 4, and 5 late toxicities reported, respectively. CONCLUSIONS Both regimens maintained high FDM rates at 7 years. Cystectomy rates were low and overall survival rates were high on both arms. Late toxicity rates were low. Either gemcitabine and daily radiation or a cisplatin-based regimen are effective bladder-sparing therapies.
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Affiliation(s)
- John J Coen
- Roger Williams Radiation Oncology, Providence, Rhode Island.
| | - Joseph P Rodgers
- NRG Oncology Statistics and Data Management Center - American College of Radiology, Philadelphia, Pennsylvania
| | | | - Cheryl T Lee
- Ohio State University Comprehensive Center, Columbus, Ohio
| | - Chin-Lee Wu
- Massachusetts General Hospital, Boston, Massachusetts
| | - William Parker
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Jason Efstathiou
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Luis Souhami
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center - American College of Radiology, Philadelphia, Pennsylvania
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Ademaj A, Puric E, Marder D, Timm O, Kern T, Hälg RA, Rogers S, Riesterer O. Radiotherapy combined with deep regional hyperthermia in elderly and frail patients with muscle-invasive bladder cancer: quality analysis of hyperthermia and impact on clinical results. Int J Hyperthermia 2023; 40:2275540. [PMID: 37932002 DOI: 10.1080/02656736.2023.2275540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose: Radiotherapy (RT) in combination with deep regional hyperthermia (HT) after transurethral removal of bladder tumor (TURBT) can be offered to elderly and frail patients with muscle-invasive bladder cancer (MIBC).Methods: In total, 21 patients (mean age 84 years) with unifocal or multifocal MIBC received radiation to a dose of 48-50 Gy/16-20 fractions with weekly HT. The primary endpoint was the variation in temperature metrics, thermal dose expressed as cumulative equivalent minutes at 43 °C when the measured temperature is T90 (CEM43T90) and net power applied in target volume per each HT session. Secondary endpoints were three-year overall survival (OS), disease-free survival (DFS), local progression-free survival (LPFS) and toxicity.Results: The temperature metrics, CEM43T90, mean and maximum net power applied did not differ significantly among the HT sessions of the 21 patients. With a median follow-up of 65 months, 52% (95% CI 32-72%) of patients had died 3 years after treatment. The three-year DFS and LPFS rates were 62% (95%CI 41-79%) and 81% (95%CI 60-92%), respectively. The three-year bladder preservation rate was 100%. Three out of four patients with local failure received a thermal dose CEM43T90 below a median of 2.4 min. The rates of acute and late grade-3 toxicities were 10% and 14%, respectively.Conclusion: The reproducibility of HT parameters between sessions was high. A moderately high CEM43T90 (> 2.4 min) for each HT session seems to be preferable for local control. RT combined with HT is a promising organ-preservation therapy for elderly and frail MIBC patients.
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Affiliation(s)
- Adela Ademaj
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
- Doctoral Clinical Science Program, Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Emsad Puric
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Dietmar Marder
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Olaf Timm
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Thomas Kern
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Roger A Hälg
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
- Institute of Physics, Science Faculty, University of Zürich, Zürich, Switzerland
| | - Susanne Rogers
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
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Moore A, Lobaugh SM, Zhang Z, Rosenberg JE, Iyer G, Teo MY, Bochner B, Donahue T, Nunez DA, Dreyfuss A, Gorovets D, Zelefsky MJ, Kollmeier MA. Hypofractionated Radiation Therapy (Hypo-RT) for the Treatment of Localized Bladder Cancer. Bladder Cancer 2023; 9:141-150. [PMID: 38993294 PMCID: PMC11181850 DOI: 10.3233/blc-220121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/25/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND Various radiotherapeutic regimens are used in the treatment of bladder cancer. OBJECTIVE We aimed to evaluate early toxicity and outcomes associated with hypofractionated radiation therapy (Hypo-RT), 55Gy in 20 fractions. MATERIAL AND METHODS We identified 40 patients who received definitive Hypo-RT for localized bladder cancer. Most patients were men (62.5%), elderly (median age 82), had high Charlson Comorbidity Index score (median 7, range 4-9) and were nonsurgical candidates (80%). Sixty-eight percent had a macroscopically complete transurethral resection of bladder tumor (TURBT) and 33 patients (82.5%) received concurrent chemotherapy. Acute (< =3mo) and late (>3mo) toxicities were assessed according to CTCAE v4.0. Survival outcomes were estimated using the Kaplan-Meier method. Median follow up after Hypo-RT was 32 months (95% CI: 28-49 months). RESULTS Overall rates of acute grade 2 genitourinary (GU) and gastrointestinal (GI) toxicities were 40% each, most commonly urinary frequency and diarrhea. Two cases of acute grade 3 GU/GI toxicity occurred. Late grade 2+ toxicity occurred in 3 patients (7.5%): 2 grade 2 GU and 1 grade 3 GI. Seventy-seven percent achieved a complete response (CR). Six patients (20%) developed disease recurrence at a median time of 9.1 months. The estimated 2-year DFS and 2-year DSS rate were 59% (95% CI, 45-78%) and 78% (95% CI, 65-93%), respectively. Receipt of concurrent chemotherapy (p = 0.003) and achieving a CR (p = 0.018) were univariably associated with improved DSS. Tis component was associated with worse DSS (p = 0.015). CONCLUSION Hypo-RT had a favorable toxicity profile and encouraging cancer control outcomes in this mostly elderly and frail patient cohort.
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Affiliation(s)
- Assaf Moore
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Tel Aviv University, Tel Aviv, Israel
| | - Stephanie M Lobaugh
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Min Yuen Teo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard Bochner
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy Donahue
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Aramburu Nunez
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexandra Dreyfuss
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel Gorovets
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Moeen AM, Faragallah MA, Zarzour MA, Elbehairy AA, Behnsawy HM. Ileal conduit versus single stoma uretero-cutanoustomy after radical cystectomy in patients ≥ 75 years; which technique is better? a prospective randomized comparative study. Int Urol Nephrol 2023:10.1007/s11255-023-03609-x. [PMID: 37133765 DOI: 10.1007/s11255-023-03609-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/21/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE To compare the clinical results and patients' health-related quality of life (HR-QoL) of ileal conduit (IC) versus single stoma uretero-cutanoustomy (SSUC) after radical cystectomy in two groups of randomly selected patients ≥ 75 years. METHODS From January 2013 to March 2018, 100 patients ≥ 75 years with muscle invasive BCa underwent RCX and cutaneous diversion. Patients were divided in two groups; group I underwent IC (50 patients) and group II underwent SSUC (50 patients). Postoperative evaluation included clinical, laboratory, radiographic and HR-QoL. The latter was performed using the Functional Assessment of Cancer Therapy-Bladder Cancer (FACT-BL) after 12 months postoperatively. RESULTS Patients' characteristics were comparable between both groups. No intraoperative complications occurred. Early postoperative complications occurred in 27 patients [16 (35.5%) in group I and 11 (23.9%) in group II (p = 0.02)]. Delayed postoperative complications occurred in 26 patients [6 (13.3%) in group I and 20 (43.4%) in group II, (P = 0.002)]. No significant differences between both groups regarding the physical, social/family, emotional, functional and additional concerns scales of FACT-BL questionnaire were reported. CONCLUSION SSUC is a good alternative to IC in elderly frail patients ≥ 75 years and those with multiple comorbidities who require rapid surgery in terms of perioperative complications and HR-QoL. However, the stomal complications and the possibility of a frequent stent exchange are considered its drawbacks.
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Affiliation(s)
- Ahmed M Moeen
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt.
| | | | - Mohamed A Zarzour
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| | - Ahmed A Elbehairy
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
| | - Hosny M Behnsawy
- Urology and Nephrology Hospital, Assiut University, Assiut, 71515, Egypt
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5
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Mignot F, Fabiano E, Xylinas E, Alati A, Méjean A, Masson-Lecomte A, Hermieu JF, Desgrandchamps F, Hennequin C, Durdux C, Quéro L. Clinical outcomes of adapted hypofractionated radiotherapy for bladder cancer in elderly patients. BJU Int 2023. [PMID: 36745012 DOI: 10.1111/bju.15983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the feasibility, efficacy, and safety of trimodal therapy (TMT) using a bifractionated split-course hypofractionated radiotherapy (RT) for non-metastatic muscle-invasive bladder cancer (MIBC) in elderly patients. PATIENTS AND METHODS We retrospectively reviewed the characteristics and outcomes of patients aged >75 years with non-metastatic MIBC suitable or not for radical cystectomy (RC) and treated with transurethral resection of bladder tumour followed by concomitant radio-chemotherapy (platinum salt and 5-fluorouracil) at two institutions (Saint Louis Hospital, Paris, France and European Georges Pompidou Hospital, Paris, France) between 1990 and 2021. RT consisted of an adapted bifractionated split-course hypofractionated RT. Acute toxicities were reported according to Common Terminology Criteria for Adverse Events version 5.0 and late toxicities were reported according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. The primary end-point was overall survival (OS). Secondary end-points included other survivals outcomes and safety. RESULTS A total of 122 patients were identified, with a median (range) follow-up of 51.1 (0.5-210.8) months. In all, 83.5% of patients completed radio-chemotherapy. The OS rate was 61.7% at 3 years and 51.2% at 5 years. In multivariate analysis, the completion of RT and concomitant chemotherapy were significantly associated with better OS and cancer-specific survival. For patients fit for RC, a complete histological response was achieved for 77 patients (91.7%) with radio-chemotherapy and the bladder conservation rate was 90.5%. Acute and late Grade ≥3 toxicities were <5%. CONCLUSION Bifractionated split-course hypofractionated RT with concomitant chemotherapy regimen appears to be well-tolerated and effective. Trimodal treatment seems to be a curative option for elderly patients unfit for radical surgery compared with palliative care and may contribute to improved survival in these patients.
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Affiliation(s)
- Fabien Mignot
- Department of Radiation Oncology, Saint Louis Hospital, AP-HP, Paris, France
| | - Emmanuelle Fabiano
- Department of Radiation Oncology, European George Pompidou Hospital, AP-HP, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Aurélia Alati
- Department of Radiation Oncology, European George Pompidou Hospital, AP-HP, Paris, France
| | - Arnaud Méjean
- Department of Urology, European George Pompidou Hospital, AP-HP, Paris, France
| | | | | | | | | | - Catherine Durdux
- Department of Radiation Oncology, European George Pompidou Hospital, AP-HP, Paris, France
| | - Laurent Quéro
- Department of Radiation Oncology, Saint Louis Hospital, AP-HP, Paris, France.,INSERM U1160, Alloimmunity-Autoimmunity-Transplantation Research Unit, University of Paris, Paris, France
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6
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Verschoor N, Heemsbergen WD, Boormans JL, Franckena M. Bladder-sparing (chemo)radiotherapy in elderly patients with muscle-invasive bladder cancer: a retrospective cohort study. Acta Oncol 2022; 61:1019-1025. [PMID: 35880448 DOI: 10.1080/0284186x.2022.2101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Organ-sparing treatment for muscle-invasive bladder cancer by maximal transurethral removal of the tumor (TURB) followed by chemoradiation (CRT) has shown promising results in recent studies, and is therefore considered to be an acceptable alternative for the standard of radical cystectomy (RC) in selected patients. We report on outcomes in a single-center, retrospective CRT cohort in comparison to a RC and radiotherapy only (RT) cohort. PATIENTS AND METHODS The patient population included n = 84 CRT patients, n = 93 RC patients, and n = 95 RT patients. Primary endpoints were local control (LC) up to 2 years and overall survival (OS) up to 5 years. Cox regression was performed to determine risk factors for LC and OS in the CRT group. Acute genito-urinary (GU) and gastro-intestinal (GI) toxicity were scored with CTCAE version 4 for the RT and CRT cohort. Logistic regression was used to determine risk factors for toxicity. We followed the EQUATOR guidelines for reporting, using the STROBE checklist for observational research. RESULTS Baseline characteristics were different between the treatment groups with in particular worse comorbidity scores and higher age in the RT cohort. The CRT schedule was completed by 96% of the patients. LC at 2 years was 83.4% (90% CI 76.0-90.8) for CRT vs. 70.9% (62.2-79.6) for RC and 67.0% (56.8-77.2) for RT. OS at 5 years was 48.9% (38.4-59.4) for CRT vs. 46.6% (36.4-56.8) for RC, and 27.6% (19.4-35.8) for RT. High T stage was significantly associated with worse LC and OS in the CRT group. GU/GI toxicity grade ≥2 occurred in 43 (48.3%) RT patients and 38 (45.2%) CRT patients. CONCLUSIONS The organ-preserving strategy with CRT was feasible and tolerable in this patient population, and the achieved LC and OS were satisfactory in comparison to the RC cohort and literature.
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Affiliation(s)
- Noortje Verschoor
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wilma D Heemsbergen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martine Franckena
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Alati A, Fabiano E, Geiss R, Mareau A, Charles-Nelson A, Bibault JE, Giraud P, Kreps S, Méjean A, Housset M, Durdux C. Bladder preservation in older adults with muscle-invasive bladder cancer: A retrospective study with concurrent chemotherapy and twice-daily hypofractionated radiotherapy schedule. J Geriatr Oncol 2022; 13:978-986. [PMID: 35717533 DOI: 10.1016/j.jgo.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bladder cancer occurs mainly in older adults and surgery is not always possible when there are geriatric conditions and comorbidities. Trimodal treatment (TMT) combining trans-urethral resection of bladder tumour (TURBT) followed by concurrent chemoradiation (CRT) would be a curative alternative in such patients. METHODS All consecutive patients 75 years of age and older with non-metastatic muscle-invasive bladder cancer (MIBC) treated with TMT by Georges Pompidou European Hospital team were retrospectively analysed. Induction CRT combined hypofractionated twice-daily radiotherapy targeting bladder and pelvis to a total dose of 24 Gy (Gy) with concurrent platinum salt and 5-fluorouracil. Consolidation CRT to a total dose of 44 Gy was proposed to patients with biopsy-proven complete response after induction phase and those with persistent tumour underwent salvage cystectomy. We assessed using Kaplan-Meier method overall survival (OS), cancer specific survival (CSS), invasive recurrence-free survival (IRFS), metastasis-free survival (MFS), survival with bladder preserved (SBP), and toxicities. With a Cox model for OS and the Fine Gray method of competing risk for secondary endpoints, we analysed in univariate (u) and multivariate (m) analysis the impact of tumour characteristics and patient profiles: gender, age, age-adjusted Charlson comorbidity index, polypharmacy, and malnutrition. RESULTS From 1988 to 2017, 85 patients were included. After induction, complete response rate was 83.5%. With a median follow-up of 63 months, 5 year-OS, CSS, IRFS, MFS and SBP were 61.0%, 77.6%, 71%, 82.9%, and 70.2% respectively. A persistent tumour after induction impacted SBP (SHRm 3.61; p = 0.004), CSS (SHRm 3.27; p = 0.023), and MFS (SHRm 3.68; p = 0.018). Late grade 3 urinary and gastrointestinal toxicities were 3.5% and 1.2%. CONCLUSION We report here the largest series of bladder preservation over 75 years in a curative intent. Outcomes and tolerance in selected older adults compared favourably with surgical series and with CRT studies using classical fractionation.
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Affiliation(s)
- Aurélia Alati
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France.
| | - Emmanuelle Fabiano
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Romain Geiss
- Geriatric Department, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Alexis Mareau
- Clinical Research Unit, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Anais Charles-Nelson
- Clinical Research Unit, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Jean-Emmanuel Bibault
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Philippe Giraud
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Sarah Kreps
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Arnaud Méjean
- Department of Urology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Martin Housset
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
| | - Catherine Durdux
- Department of Radiation Oncology, Georges Pompidou European Hospital, University of Paris Descartes, Paris, France
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8
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Jameus A, Kennedy AE, Thome C. Hematological Changes Following Low Dose Radiation Therapy and Comparison to Current Standard of Care Cancer Treatments. Dose Response 2021; 19:15593258211056196. [PMID: 34803549 PMCID: PMC8600563 DOI: 10.1177/15593258211056196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/31/2022] Open
Abstract
Cancer is the second leading cause of mortality worldwide accounting for almost 10 million deaths in 2020. Current standard of care treatment varies depending on the type and stage of disease, but commonly includes surgery, chemotherapy, and/or radiation therapy. There is evidence that whole- and half-body exposure to low dose ionizing radiation can also be an effective therapeutic due to its stimulation of anti-cancer immunity. One of the limiting factors for past clinical trials using low dose radiation therapy has been adverse hematological events. However, similar hematological changes are also frequently reported following standard of care treatments in oncology. This review summarizes the effects of various cancer therapies on hematologic toxicity through the evaluation of complete blood count reports. The reviewed literature elucidates hematological trends in patients undergoing chemotherapy, and both high and low dose radiation therapy. In general, high dose radiation and chemotherapy can result in widespread changes in blood counts, with the most severe effects related to leukopenia. Overall, compared to standard of care treatments, low dose radiation results in similar, yet more mild hematological changes. Taken together, hematological toxicities should not be a limiting factor in the applicability of low dose radiation as a cancer therapeutic.
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Affiliation(s)
- Alexandra Jameus
- Department of Biology, Laurentian University, Sudbury, ON, Canada
| | - Allison E Kennedy
- McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada.,Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher Thome
- Department of Biology, Laurentian University, Sudbury, ON, Canada.,Northern Ontario School of Medicine, Sudbury, ON, Canada.,Nuclear Innovation Institute, Port Elgin, ON, Canada.,Biomolecular Sciences Program, Laurentian University, Sudbury, ON, Canada
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9
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Xiang M, Chang AJ, Chamie K, Drakaki A, Pollom EL, Steinberg ML, Kishan AU. Trends and Predictors of Hypofractionated and Intensity-Modulated Radiotherapy for Organ Preservation in Bladder Cancer. Clin Genitourin Cancer 2021; 20:e94-e103. [PMID: 34866018 DOI: 10.1016/j.clgc.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Use of hypofractionated radiation (HFRT) and intensity-modulated radiation (IMRT) for organ preservation in bladder cancer is controversial and highly variable. We investigated practice patterns, trends, and predictors of HFRT and IMRT. PATIENTS AND METHODS The National Cancer Database was queried for patients with muscle-invasive, non-metastatic urothelial bladder cancer, treated with definitive (chemo)radiotherapy between 2004 and 2017. HFRT was defined as 50 to 60 Gy at >2 Gy/fraction. Multivariable logistic regression was used to identify predictors of receiving HFRT or IMRT. Multivariable Cox regression was used to model overall survival (OS), adjusting for potential confounders such as age, comorbidity, and chemotherapy. RESULTS Of 5132 patients identified, 490 (9.5%) received HFRT, and only 334 (6.5%) received ≥2.5 Gy/fraction. HFRT patients were significantly older, less fit, and less likely to receive chemotherapy relative to CFRT, even after controlling for age and comorbidity (adjusted odds ratio 0.36, 95% confidence interval [CI] 0.29-0.45, P < .0001). Utilization of HFRT and IMRT increased over time (P < .0001), reaching 22.5% and 47.7%, respectively, by 2017. Among patients treated with CFRT, OS was similar with or without IMRT (P = .46). Among patients treated with HFRT, IMRT was associated with increased survival (3-year OS 35% vs. 24%, P = .03), which persisted in multivariable analysis (adjusted hazard ratio 0.71, 95% CI 0.52-0.98, P = .04). CONCLUSION HFRT is largely underutilized, being primarily reserved for older, frailer patients. Chemotherapy is significantly underused with HFRT relative to CFRT. IMRT is used frequently and was associated with equivalent or modestly increased overall survival.
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Affiliation(s)
- Michael Xiang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
| | - Albert J Chang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Alexandra Drakaki
- Department of Urologic Oncology, University of California Los Angeles, Los Angeles, CA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
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10
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Standard Versus Hypofractionated Radiation Therapy for Bladder Cancer: New Insights, but Questions Remain. Int J Radiat Oncol Biol Phys 2021; 111:113-116. [PMID: 34348106 DOI: 10.1016/j.ijrobp.2021.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/21/2021] [Accepted: 04/29/2021] [Indexed: 11/23/2022]
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11
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Marcq G, Souhami L, Cury FL, Salimi A, Aprikian A, Tanguay S, Vanhuyse M, Rajan R, Brimo F, Mansure JJ, Kassouf W. Phase 1 Trial of Atezolizumab Plus Trimodal Therapy in Patients With Localized Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2021; 110:738-741. [PMID: 33421558 DOI: 10.1016/j.ijrobp.2020.12.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Immune checkpoint programmed death-ligand 1 inhibitor therapy has shown response in metastatic muscle invasive bladder cancer (MIBC). We evaluated the safety and tolerability of atezolizumab (anti-programmed death-ligand 1) in combination with trimodal therapy in patients with localized MIBC. METHODS AND MATERIALS A prospective nonrandomized phase 1 study using a 3 + 3 design was conducted in patients with localized MIBC (T2-T4a N0M0) treated on a bladder preservation program. After transurethral resection of bladder tumor, patients received concurrent radiation therapy at a fixed dose of 50 Gy in 20 fractions, gemcitabine (100 mg/m2, intravenously once weekly for 4 weeks) and atezolizumab (1200 mg intravenously every 3 weeks for 16 cycles). The primary endpoint was safety/toxicity profile. RESULTS Between May 2018 and March 2019, 8 patients (6 male and 2 female) were enrolled. The first 5 patients received atezolizumab at 1200 mg, 3 of whom developed grade 3 side effects (2 of them dose-limiting toxicity). Atezolizumab dose was reduced to 840 mg for 3 additional patients. The study was terminated due to the presence of 3 grade 3 adverse events (2 of which were dose-limiting toxicity) despite the reduced atezolizumab dose. Gastrointestinal events were the main toxicity. No grade 4 to 5 adverse effects were observed. CONCLUSIONS Concurrent administration of atezolizumab with concomitant hypofractionated radiation therapy and gemcitabine appears to be associated with unacceptable gastrointestinal toxicity. Although the numbers studied are small, our results suggest considerable caution with its concurrent use with trimodal therapy for MIBC.
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Affiliation(s)
- Gautier Marcq
- Division of Urology, University Health Centre, McGill University, Montreal, Canada
| | - Luis Souhami
- Division of Radiation Oncology, University Health Centre, McGill University, Montreal, Canada
| | - Fabio L Cury
- Division of Radiation Oncology, University Health Centre, McGill University, Montreal, Canada
| | - Afsar Salimi
- Center of Innovation, University Health Centre, McGill University, Montreal, Canada
| | - Armen Aprikian
- Division of Urology, University Health Centre, McGill University, Montreal, Canada
| | - Simon Tanguay
- Division of Urology, University Health Centre, McGill University, Montreal, Canada
| | - Marie Vanhuyse
- Department of Medical Oncology, University Health Centre, McGill University, Montreal, Canada
| | - Raghu Rajan
- Department of Medical Oncology, University Health Centre, McGill University, Montreal, Canada
| | - Fadi Brimo
- Department of Pathology, University Health Centre, McGill University, Montreal, Canada
| | - José João Mansure
- Division of Urology, University Health Centre, McGill University, Montreal, Canada
| | - Wassim Kassouf
- Division of Urology, University Health Centre, McGill University, Montreal, Canada.
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Walshaw RC, Hoskin PJ, Choudhury A. Can Hypofractionation and Immune Modulation Coexist? Int J Radiat Oncol Biol Phys 2021; 110:742-744. [PMID: 34089680 DOI: 10.1016/j.ijrobp.2021.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Richard C Walshaw
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Peter J Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
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Khalifa J, Supiot S, Pignot G, Hennequin C, Blanchard P, Pasquier D, Magné N, de Crevoisier R, Graff-Cailleaud P, Riou O, Cabaillé M, Azria D, Latorzeff I, Créhange G, Chapet O, Rouprêt M, Belhomme S, Mejean A, Culine S, Sargos P. Recommendations for planning and delivery of radical radiotherapy for localized urothelial carcinoma of the bladder. Radiother Oncol 2021; 161:95-114. [PMID: 34118357 DOI: 10.1016/j.radonc.2021.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Curative radio-chemotherapy is recognized as a standard treatment option for muscle-invasive bladder cancer (MIBC). Nevertheless, the technical aspects for MIBC radiotherapy are heterogeneous with a lack of practical recommendations. METHODS AND MATERIALS In 2018, a workshop identified the need for two cooperative groups to develop consistent, evidence-based guidelines for irradiation technique in the delivery of curative radiotherapy. Two radiation oncologists performed a review of the literature addressing several topics relative to radical bladder radiotherapy: planning computed tomography acquisition, target volume delineation, radiation schedules (total dose and fractionation) and dose delivery (including radiotherapy techniques, image-guided radiotherapy (IGRT) and adaptive treatment modalities). Searches for original and review articles in the PubMed and Google Scholar databases were conducted from January 1990 until March 2020. During a meeting conducted in October 2020, results on 32 topics were presented and discussed with a working group involving 15 radiation oncologists, 3 urologists and one medical oncologist. We applied the American Urological Association guideline development's method to define a consensus strategy. RESULTS A consensus was obtained for all 34 except 4 items. The group did not obtain an agreement on CT enhancement added value for planning, PTV margins definition for empty bladder and full bladder protocols, and for pelvic lymph-nodes irradiation. High quality evidence was shown in 6 items; 8 items were considered as low quality of evidence. CONCLUSION The current recommendations propose a homogenized modality of treatment both for routine clinical practice and for future clinical trials, following the best evidence to date, analyzed with a robust methodology. The XXX group formulates practical guidelines for the implementation of innovative techniques such as adaptive radiotherapy.
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Affiliation(s)
- Jonathan Khalifa
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | | | - Pierre Blanchard
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Nicolas Magné
- Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France
| | | | - Pierre Graff-Cailleaud
- Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, France
| | - Olivier Riou
- Department of Radiotherapy, Institut du Cancer de Montpellier, France
| | | | - David Azria
- Department of Radiotherapy, Institut du Cancer de Montpellier, France
| | - Igor Latorzeff
- Department of Radiotherapy, Clinique Pasteur, Toulouse, France
| | | | - Olivier Chapet
- Department of Radiotherapy, Hospices Civils de Lyon, France
| | - Morgan Rouprêt
- Department of Urology, Hôpital Pitié-Salpétrière, APHP Sorbonne Université, Paris, France
| | - Sarah Belhomme
- Department of Medical Physics, Institut Bergonié, Bordeaux, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France.
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Datta NR, Marder D, Datta S, Meister A, Puric E, Stutz E, Rogers S, Eberle B, Timm O, Staruch M, Riesterer O, Bodis S. Quantification of thermal dose in moderate clinical hyperthermia with radiotherapy: a relook using temperature-time area under the curve (AUC). Int J Hyperthermia 2021; 38:296-307. [PMID: 33627018 DOI: 10.1080/02656736.2021.1875060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Thermal dose in clinical hyperthermia reported as cumulative equivalent minutes (CEM) at 43 °C (CEM43) and its variants are based on direct thermal cytotoxicity assuming Arrhenius 'break' at 43 °C. An alternative method centered on the actual time-temperature plot during each hyperthermia session and its prognostic feasibility is explored. METHODS AND MATERIALS Patients with bladder cancer treated with weekly deep hyperthermia followed by radiotherapy were evaluated. From intravesical temperature (T) recordings obtained every 10 secs, the area under the curve (AUC) was computed for each session for T > 37 °C (AUC > 37 °C) and T ≥ 39 °C (AUC ≥ 39 °C). These along with CEM43, CEM43(>37 °C), CEM43(≥39 °C), Tmean, Tmin and Tmax were evaluated for bladder tumor control. RESULTS Seventy-four hyperthermia sessions were delivered in 18 patients (median: 4 sessions/patient). Two patients failed in the bladder. For both individual and summated hyperthermia sessions, the Tmean, CEM43, CEM43(>37 °C), CEM43(≥39 °C), AUC > 37 °C and AUC ≥ 39 °C were significantly lower in patients who had a local relapse. Individual AUC ≥ 39 °C for patients with/without local bladder failure were 105.9 ± 58.3 °C-min and 177.9 ± 58.0 °C-min, respectively (p = 0.01). Corresponding summated AUC ≥ 39 °C were 423.7 ± 27.8 °C-min vs. 734.1 ± 194.6 °C-min (p < 0.001), respectively. The median AUC ≥ 39 °C for each hyperthermia session in patients with bladder tumor control was 190 °C-min. CONCLUSION AUC ≥ 39 °C for each hyperthermia session represents the cumulative time-temperature distribution at clinically defined moderate hyperthermia in the range of 39 °C to 45 °C. It is a simple, mathematically computable parameter without any prior assumptions and appears to predict treatment outcome as evident from this study. However, its predictive ability as a thermal dose parameter merits further evaluation in a larger patient cohort.
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Affiliation(s)
- Niloy R Datta
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Dietmar Marder
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Sneha Datta
- Animal Production and Health Laboratory, Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Andreas Meister
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emsad Puric
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Stutz
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Susanne Rogers
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Brigitte Eberle
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Olaf Timm
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Michal Staruch
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | - Stephan Bodis
- Department of Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Switzerland
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Swinton M, Choudhury A, Kiltie AE, Chung P, Billfalk-Kelly A, James N, Kamran SC, Efstathiou JA. Trimodal Therapy. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tholomier C, Souhami L, Kassouf W. Bladder-sparing protocols in the treatment of muscle-invasive bladder cancer. Transl Androl Urol 2020; 9:2920-2937. [PMID: 33457265 PMCID: PMC7807363 DOI: 10.21037/tau.2020.02.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
Bladder-sparing protocols (BSP) have been gaining widespread popularity as an attractive alternative to radical cystectomy (RC) for muscle-invasive bladder cancer. Unimodal therapies are inferior to multimodal regimens. The most promising regimen is trimodal therapy (TMT), which is a combination of maximal transurethral resection of bladder tumor (TURBT), radiotherapy, and chemotherapy. In appropriately selected patients (low volume unifocal T2 disease, complete TURBT, no hydronephrosis and no carcinoma-in-situ), comparable oncological outcomes to RC have been reported in large retrospective studies, with a potential improvement in overall quality of life (QOL). TMT also offers the possibility for definitive therapy for patients who are not surgically fit to undergo RC. Routine biopsy of previous tumor resection is recommended to assess response. Prompt salvage RC is required in non-responders and for recurrent muscle-invasive disease, while non-muscle-invasive recurrence can be managed conservatively with TURBT +/- intravesical BCG. Long-term follow-up consisting of routine cystoscopy, urine cytology, and cross-section imaging is required. Further studies are warranted to better define the role of neoadjuvant or adjuvant chemotherapy in the setting of TMT. Finally, future research on predictive markers of response to TMT and on the integration of immunotherapy in bladder sparing protocols is ongoing and is highly promising.
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Affiliation(s)
- Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, Montréal, Québec, Canada
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Prospective evaluation of definitive chemoradiotherapy with volumetric modulated arc therapy in patients with muscle invasive carcinoma of urinary bladder. Contemp Oncol (Pozn) 2020; 24:177-182. [PMID: 33235544 PMCID: PMC7670179 DOI: 10.5114/wo.2020.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/25/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction Concurrent chemoradiotherapy (CTRT) remains one of the treatment options in patients with muscle invasive bladder cancer (MIBC) unwilling/unsuitable for radical surgery. We evaluated the role of volumetric modulated arc therapy (VMAT) in MIBC patients treated with definitive CTRT. Material and methods 25 patients of histologically proven transitional cell MIBC (T2–T4a, N0, M0) unwilling/unsuitable for radical surgery (after maximal transurethral resection of bladder tumour) were recruited in this prospective study. Primary clinical target volume (CTV) consisted of the gross tumour and whole bladder. Primary planning target volume (PTV) and nodal PTV were prescribed 60 Gy and 54 Gy (both in 30 fractions). Concurrent chemotherapy was cisplatin (40 mg/m2) weekly. Acute toxicities were assessed as per Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Survival estimates were done from the date of registration using the Kaplan-Meier method. Results Median age was 70 years (37–80 years). Median overall treatment time was 45 days (44–51). Median number of chemotherapy cycles was 5 (range 3–6). 5 (20%) and 4 (16%) patients respectively suffered from acute grade ≥ 2 gastrointestinal and grade ≥ 2 genitourinary toxicities during treatment. One patient each had grade 3 anaemia and neutropenia. At a median follow-up of 34 months (10–45 months), 3-year progression-free survival and overall survival were 65.6% and 81.2% respectively. 3-year distant metastasis-free survival was 90.5%. Bladder preservation rate at 3 years was 68%. Conclusions Definitive CTRT with VMAT is well tolerated in patients with MIBC unsuitable for surgery and yields decent survival and bladder preservation outcome.
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Cardoso M, Choudhury A, Christie D, Eade T, Foroudi F, Hayden A, Holt T, Kneebone A, Sasso G, Shakespeare TP, Sidhom M. FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC. J Med Imaging Radiat Oncol 2020; 64:882-893. [DOI: 10.1111/1754-9485.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Michael Cardoso
- Cancer Therapy Centre Liverpool Hospital New South Wales Australia
- Centre for Medical Radiation Physics University of Wollongong Wollongong New South Wales Australia
- South Western Sydney Clinical School University of New South Wales New South Wales Australia
| | - Ananya Choudhury
- Division of Cancer Sciences University of Manchester Manchester UK
- The Christie NHS Foundation Trust Manchester UK
| | - David Christie
- Genesis Cancer Care Queensland Australia
- Department of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Thomas Eade
- Northern Sydney Cancer CentreRoyal North Shore Hospital New South Wales Australia
- Northern Medical School University of Sydney Sydney New South Wales Australia
| | - Farshad Foroudi
- Department of Radiation Oncology Newton‐John Cancer Wellness and Research CentreAustin Health Heidelberg Victoria Australia
- Latrobe University Melbourne Victoria Australia
| | - Amy Hayden
- Sydney West Radiation Oncology Westmead Hospital Sydney New South Wales Australia
| | - Tanya Holt
- Princess Alexandra Hospital‐ROPART Brisbane Queensland Australia
- University of Queensland Queensland Australia
| | - Andrew Kneebone
- Northern Sydney Cancer CentreRoyal North Shore Hospital New South Wales Australia
- Northern Medical School University of Sydney Sydney New South Wales Australia
- Central Coast Cancer Centre Gosford Hospital Gosford New South Wales Australia
- Genesis Cancer Care New South Wales Australia
| | - Giuseppe Sasso
- Radiation Oncology Department Auckland District Health Board Auckland New Zealand
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Thomas P. Shakespeare
- Department of Radiation Oncology Mid North Coast Cancer Institute Coffs Harbour New South Wales Australia
- University of New South Wales Rural Clinical School Coffs Harbour Australia
| | - Mark Sidhom
- Cancer Therapy Centre Liverpool Hospital New South Wales Australia
- South Western Sydney Clinical School University of New South Wales New South Wales Australia
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Mansour AM, Kaushik D. Author Reply. Urology 2019; 133:172-173. [DOI: 10.1016/j.urology.2019.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ali A, Song YP, Mehta S, Mistry H, Conroy R, Coyle C, Logue J, Tran A, Wylie J, Janjua T, Joseph L, Joseph J, Choudhury A. Palliative Radiation Therapy in Bladder Cancer—Importance of Patient Selection: A Retrospective Multicenter Study. Int J Radiat Oncol Biol Phys 2019; 105:389-393. [DOI: 10.1016/j.ijrobp.2019.06.2541] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/17/2022]
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Datta NR, Stutz E, Puric E, Eberle B, Meister A, Marder D, Timm O, Rogers S, Wyler S, Bodis S. A Pilot Study of Radiotherapy and Local Hyperthermia in Elderly Patients With Muscle-Invasive Bladder Cancers Unfit for Definitive Surgery or Chemoradiotherapy. Front Oncol 2019; 9:889. [PMID: 31552192 PMCID: PMC6746906 DOI: 10.3389/fonc.2019.00889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose: To present the outcomes of a pilot study with hyperthermia (HT) and radiotherapy (RT) in elderly patients of muscle-invasive bladder cancers (MIBC) unfit for surgery or chemoradiotherapy (CTRT). Methods: Sixteen elderly patients with unifocal or multifocal MIBCs received a total dose of 48 Gy/16 fractions/4 weeks or 50 Gy/20 fractions/4 weeks, respectively. HT with a radiofrequency HT unit was delivered once weekly for 60 min before RT and a mean temperature of 41.3°C was attained (maximum temperature 41.1–43.5°C). Local control was assessed using RECIST criteria at 3-monthly intervals by cystoscopy with or without biopsy. Results: The median age, KPS and age-adjusted Charlson comorbidity index were 81 years, 70 and 5, respectively. At median follow-up of 18.5 months (range: 4–65), bladder preservation was 100% with satisfactory function. 11/16 patients (68.7%) had no local and/or distant failure, while isolated local, distant and combined local and distant failures were evident in 2, 2, and 1 patient, respectively. Two local failures were salvaged by TUR-BT resulting in a local control rate of 93.7%. The 5-year cause-specific (CS) local disease free survival (LDFS), disease free survival (DFS), and overall survival (OS) were 64.3, 51.6, and 67.5%, respectively while 5-year non-cause-specific (NCS)-LDFS, NCS-DFS, and NCS-OS were 26.5, 23.2, and 38%, respectively. None of the patients had acute or late grade 3/4 gastrointestinal or genitourinary toxicities. Conclusions: The outcomes from this pilot study indicate that thermoradiotherapy is a feasible therapeutic modality in elderly MIBC patients unfit for surgery or CTRT. HTRT is well-tolerated, allows bladder preservation and function, achieves long-term satisfactory locoregional control and is devoid of significant treatment-related morbidity. This therapeutic approach deserves further evaluation in randomized studies.
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Affiliation(s)
- Niloy Ranjan Datta
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Stutz
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Emsad Puric
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Brigitte Eberle
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Meister
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Dietmar Marder
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Olaf Timm
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Susanne Rogers
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephen Wyler
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland.,Department of Radiation Oncology, University Hospital Zürich, Zurich, Switzerland
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Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group. Cancers (Basel) 2019; 11:cancers11030371. [PMID: 30884827 PMCID: PMC6468336 DOI: 10.3390/cancers11030371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023] Open
Abstract
The management of older cancer patients remains difficult because of data paucity. Radiation oncologists need to identify potential issues which could affect treatment of those patients. A workshop was organized in Barcelona among international radiation oncologists with special interest in the management of older cancer patients on April 22, 2018. The following consensus was reached: 1. Older cancer patients often faced unconscious discriminating bias from cancer specialists and institutions because of their chronological age. 2. Advances in radiotherapy techniques have allowed patients with multiple co-morbidities precluding surgery or systemic therapy to achieve potential cure in early disease stages. 3. The lack of biomarkers for frailty remains an impediment to future research. 4. Access to healthcare insurance and daily transportation remains an issue in many countries; 5. Hypofractionation, brachytherapy, or stereotactic techniques may be ideally suited for older cancer patients to minimize transportation issues and to improve tolerance to radiotherapy. 6. Patients with locally advanced disease who are mentally and physically fit should receive combined therapy for potential cure. 7. The role of systemic therapy alone or combined with radiotherapy for frail patients needs to be defined in future clinical trials because of targeted agents or immunotherapy may be less toxic compared to conventional chemotherapy.
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Accelerated Hypofractionated Radiation Therapy for Elderly Frail Bladder Cancer Patients Unfit for Surgery or Chemotherapy. Am J Clin Oncol 2019; 42:179-183. [DOI: 10.1097/coc.0000000000000491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whole Versus Partial Bladder Radiation: Use of an Image-guided Hypofractionated IMRT Bladder-preservation Protocol. Am J Clin Oncol 2019; 41:107-114. [PMID: 26535994 DOI: 10.1097/coc.0000000000000237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To report our institutional experience using definitive chemoradiation via whole bladder (WB) and partial bladder (PB) treatment in muscle-invasive bladder cancer. Combining intensity-modulated radiation therapy with image-guidance can improve the therapeutic ratio. MATERIALS AND METHODS Retrospective analysis of 26 patients with clinical stage T2-4 N0-2 M0 urothelial cancer treated in 2009 to 2012; 16 received WB radiation and 10 received PB radiation. PB/tumor boost volume included visibly thickened bladder wall or tumor localized on cystoscopy. WB radiation delivered 45 to 50.4 Gy to bladder/lymph nodes, then sequential 19.8 to 21.6 Gy tumor boost (1.8 Gy/fx). PB radiation was 45 to 50 Gy to lymph nodes (1.8 to 2 Gy/fx) and simultaneous integrated boost to 55 to 62.5 Gy to tumor only (2.2 to 2.5 Gy/fx). The primary endpoint was local control, defined as no muscle-invasive recurrence. Secondary endpoints were overall survival, toxicity, and cost. RESULTS Mean age was 77 and median follow-up was 20 months. Freedom from local recurrence was 86% at 2 years (PB 100%, WB 77%). Overall survival was 80% at 1 year (PB 88%, WB 75%), and 55% at 2 years (PB 70%, WB 48%, P=0.38). Failure was predominantly distant. Toxicities were minimal (3 late grade 3 ureteral, 1 acute grade 4 renal), and all resolved. No cystectomies were performed for toxicity. Hypofractionation reduces treatment time and costs by one third. CONCLUSIONS Image-guided hypofractionated PB radiation provides local control with similar survival to WB therapy, with minimal toxicity. Hypofractionation also offers time and cost advantages. Our results need to be validated in a larger, multi-institutional cohort.
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Anisotropic Bladder Planning Target Volume in Bladder Radiation Therapy. Pract Radiat Oncol 2019; 9:24-28. [DOI: 10.1016/j.prro.2018.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/09/2018] [Accepted: 07/28/2018] [Indexed: 11/16/2022]
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Coen JJ, Zhang P, Saylor PJ, Lee CT, Wu CL, Parker W, Lautenschlaeger T, Zietman AL, Efstathiou JA, Jani AB, Kucuk O, Souhami L, Rodgers JP, Sandler HM, Shipley WU. Bladder Preservation With Twice-a-Day Radiation Plus Fluorouracil/Cisplatin or Once Daily Radiation Plus Gemcitabine for Muscle-Invasive Bladder Cancer: NRG/RTOG 0712-A Randomized Phase II Trial. J Clin Oncol 2018; 37:44-51. [PMID: 30433852 DOI: 10.1200/jco.18.00537] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Fluorouracil plus cisplatin and radiation twice a day (FCT) is an established chemoradiation (CRT) regimen for selective bladder-sparing treatment of muscle-invasive bladder cancer. Gemcitabine and once daily radiation (GD) is a well-supported alternative. The current trial evaluates these regimens. METHODS Patients with cT2-4a muscle-invasive bladder cancer were randomly assigned to FCT or GD. Patients underwent transurethral resection and induction CRT to 40 Gy. Patients who achieved a complete response (CR) received consolidation CRT to 64 Gy and others underwent cystectomy. We administered adjuvant gemcitabine/cisplatin chemotherapy. The primary end point was the rate of freedom from distant metastasis at 3 years (DMF3). The trial was not statistically powered to compare regimens, but to assess whether either regimen exceeded a DMF3 benchmark of 75%. Toxicity and efficacy end points, including CR and bladder-intact distant metastasis free survival at 3 years (BI-DMFS3), were assessed. RESULTS From December 2008 to April 2014, 70 patients were enrolled, of which 66 were eligible for analysis, 33 per arm. Median follow-up was 5.1 years (range, 0.4 to 7.8 years) for eligible living patients. DMF3 was 78% and 84% for FCT and GD, respectively. BI-DMFS3 was 67% and 72%, respectively. Postinduction CR rates were 88% and 78%, respectively. Of 33 patients in the FCT arm, 21 (64%) experienced treatment-related grade 3 and 4 toxicities during protocol treatment, with 18 (55%), two (6%), and two patients (6%) experiencing grade 3 and 4 hematologic, GI, and genitourinary toxicity, respectively. For the 33 patients in the GD arm, these figures were 18 (55%) overall and 14 (42%), three (9%) and two patients (6%), respectively. CONCLUSION Both regimens demonstrated DMF3 greater than 75%. There were fewer toxicities observed in the GD arm. Either gemcitabine and once daily radiation or a cisplatin-based regimen could serve as a base for future trials of systemic therapy.
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Affiliation(s)
| | | | - Philip J Saylor
- 3 Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Chin-Lee Wu
- 3 Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - William Parker
- 5 McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Anthony L Zietman
- 3 Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | - Omer Kucuk
- 7 Cedars-Sinai Medical Center, Los Angeles, CA
| | - Luis Souhami
- 5 McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - William U Shipley
- 3 Massachusetts General Hospital and Harvard Medical School, Boston, MA
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El-Achkar A, Souhami L, Kassouf W. Bladder Preservation Therapy: Review of Literature and Future Directions of Trimodal Therapy. Curr Urol Rep 2018; 19:108. [PMID: 30392150 DOI: 10.1007/s11934-018-0859-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW This review targets the latest literature on bladder preservation therapy with emphasis on trimodal therapy (TMT), highlighting its role in the management of muscle invasive bladder cancer (MIBC) and outlining future directions in bladder preservation research. RECENT FINDINGS TMT is the most promising bladder preservation treatment modality. Comparable results to contemporary radical cystectomy series are seen in properly selected patients. A multidisciplinary team approach is critical in the management of these patients. Future research is directed at the integration of immunotherapy into the treatment protocol. TMT, involving maximal transurethral resection followed by chemoradiation, is an attractive alternative to radical cystectomy with urinary diversion in carefully selected patients with muscle invasive disease. In the absence of randomized trial (RCT), comparison between TMT and cystectomy, based on retrospective data from large centers, suggests comparable oncological outcomes, with a favorable impact on quality of life.
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Affiliation(s)
- Adnan El-Achkar
- Experimental surgery, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Wassim Kassouf
- Department of Surgery, McGill University Health Center, McGill University, 1001 Decarie Blvd, D02.7210, Montreal, QC, H4A 3J1, Canada.
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Mathes J, Rausch S, Todenhöfer T, Stenzl A. Trimodal therapy for muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2018; 18:1219-1229. [DOI: 10.1080/14737140.2018.1535314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joachim Mathes
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University of Tübingen, Tübingen, Germany
| | | | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
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El-Achkar A, Kassouf W. Re: Propensity Score Analysis of Radical Cystectomy Versus Bladder-sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic. Eur Urol 2018; 73:810-811. [PMID: 29454473 DOI: 10.1016/j.eururo.2018.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/27/2018] [Indexed: 10/18/2022]
Affiliation(s)
| | - Wassim Kassouf
- Department of Surgery, McGill University, Montreal, Canada.
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30
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Monteiro LL, Kassouf W. Radical Cystectomy is the best choice for most patients with muscle-invasive bladder cancer? | Opinion: Yes. Int Braz J Urol 2017; 43:184-187. [PMID: 28328186 PMCID: PMC5433354 DOI: 10.1590/s1677-5538.ibju.2017.02.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Leonardo L Monteiro
- Division of Urology, McGill University Health Center, Montreal, Quebec, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, Quebec, Canada
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31
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Bonet M, Bonfill T, Nuñez M, Mur E, Arenas M. Trimodality therapy for older patients with bladder cancer: Overtreatment or benefit? J Geriatr Oncol 2017; 9:279-280. [PMID: 29233549 DOI: 10.1016/j.jgo.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 09/28/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marta Bonet
- Hospital Universitari Sant Joan de Reus, Department of Radiation Oncology, Tarragona, Spain; Consorci Sanitari de Terrassa, Department of Radiation Oncology, Terrassa, Spain.
| | - Teresa Bonfill
- Hospital Universitari Parc Taulí, Department of Medical Oncology, Sabadell, Spain
| | - Miriam Nuñez
- Consorci Sanitari de Terrassa, Department of Radiation Oncology, Terrassa, Spain
| | - Encarna Mur
- Consorci Sanitari de Terrassa, Department of Radiation Oncology, Terrassa, Spain
| | - Meritxell Arenas
- Hospital Universitari Sant Joan de Reus, Department of Radiation Oncology, Tarragona, Spain
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32
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Inamoto T, Ibuki N, Komura K, Juri H, Yamamoto K, Yamamoto K, Fujita K, Nonomura N, Narumi Y, Azuma H. Can bladder preservation therapy come to the center stage? Int J Urol 2017; 25:134-140. [PMID: 29171098 DOI: 10.1111/iju.13495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/23/2017] [Indexed: 12/17/2022]
Abstract
Decision-making in urological cancer care requires a multidisciplinary approach for refinement, but its impact on urothelial carcinoma of the bladder has not been fully addressed for the past three decades, except for the latest immunological checkpoint inhibitor approved by the U.S. Food and Drug Administration for metastatic muscle-invasive bladder cancer that is resistant to platinum-based chemotherapy. For the time being, radical cystectomy is the gold standard of curative therapy for muscle-invasive bladder cancer. Trimodal therapy that combines chemotherapy for the purpose of radiation sensitization, external beam radiotherapy and transurethral resection of bladder tumor has emerged as a potential alternative treatment option that preserves the bladder. In lack of randomized studies for bladder preservation therapy compared with surgery, the principles of management of urothelial carcinoma of the bladder have evolved in recent times, with an emphasis on bladder preservation. A number of bladder preservation techniques are available to the surgeon; however, appropriately selected patients with muscle-invasive bladder cancer should be offered the opportunity to discuss various treatment options, including organ-sparing trimodal therapy. The aim of the present study was to compare the primary outcomes of the available treatment methods and identify the sources of variance among studies. A review of various bladder preservation techniques in vogue for the management of urothelial carcinoma of the bladder is discussed.
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Affiliation(s)
- Teruo Inamoto
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naokazu Ibuki
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hiroshi Juri
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kiyohito Yamamoto
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Norio Nonomura
- Department of Urology, Osaka University, Suita, Osaka, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Takatsuki, Osaka, Japan
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Bonet M, Bonfill T, Nuñez M, De Verdonces L, Mur E, Gallardo E, Fernandez-Morales L, Aguilar A, Prats J, Arenas M. Curative radiation therapy for very elderly bladder cancer patients with localized disease. Clin Transl Oncol 2017; 20:899-905. [DOI: 10.1007/s12094-017-1804-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
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34
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Haque W, Verma V, Butler EB, Teh BS. Chemotherapy Versus Chemoradiation for Node-Positive Bladder Cancer: Practice Patterns and Outcomes from the National Cancer Data Base. Bladder Cancer 2017; 3:283-291. [PMID: 29152552 PMCID: PMC5676760 DOI: 10.3233/blc-170137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Management of clinically node-positive bladder cancer (cN+ BC) is poorly defined; national guidelines recommend chemotherapy (CT) alone or chemoradiation (CRT). Objective: Using a large, contemporary dataset, we evaluated national practice patterns and outcomes of CT versus CRT to elucidate the optimal therapy for this patient population. Methods: The National Cancer Data Base (NCDB) was queried (2004–2013) for patients diagnosed with cTanyN1-3M0 BC. Patients were divided into two groups: CT alone or CRT. Statistics included multivariable logistic regression to determine factors predictive of receiving additional radiotherapy, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS. Propensity score matching was performed to assess groups in a balanced manner while reducing indication biases. Results: Of 1,783 total patients, 1,388 (77.8%) underwent CT alone, and 395 (22.2%) CRT. Although patients receiving CRT tended to be of higher socioeconomic status, they were more likely older (p = 0.053), higher T stage, N1 (versus N2) disease, squamous histology, and treated at a non-academic center (p < 0.05). Median overall survival (OS) was 19.0 months and 13.8 months (p < 0.001) for patients receiving CRT or CT, respectively. On Cox multivariate analysis, receipt of CRT was independently associated with improved survival (p < 0.001). Outcome improvements with CRT persisted on evaluation of propensity-matched populations (p < 0.001). Conclusions: CRT is underutilized in the United States for cN+ BC but is independently associated with improved survival despite being preferentially administered to a somewhat higher-risk population.
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Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, CHI St Lukes Health, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
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Korpics MC, Block AM, Martin B, Hentz C, Gaynor ER, Henry E, Harkenrider MM, Solanki AA. Concurrent chemotherapy is associated with improved survival in elderly patients with bladder cancer undergoing radiotherapy. Cancer 2017; 123:3524-3531. [DOI: 10.1002/cncr.30719] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/25/2017] [Accepted: 03/14/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Mark C. Korpics
- Department of Radiation Oncology; Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
| | - Alec M. Block
- Department of Radiation Oncology; Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
| | - Brendan Martin
- Clinical Research Office; Health Sciences Division, Loyola University Chicago; Maywood Illinois
| | - Courtney Hentz
- Department of Radiation Oncology; Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
| | - Ellen R. Gaynor
- Division of Hematology/Oncology; Department of Medicine, Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
| | - Elizabeth Henry
- Division of Hematology/Oncology; Department of Medicine, Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
| | - Matthew M. Harkenrider
- Department of Radiation Oncology; Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
| | - Abhishek A. Solanki
- Department of Radiation Oncology; Stritch School of Medicine, Loyola University Chicago; Maywood Illinois
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Hafeez S, McDonald F, Lalondrelle S, McNair H, Warren-Oseni K, Jones K, Harris V, Taylor H, Khoo V, Thomas K, Hansen V, Dearnaley D, Horwich A, Huddart R. Clinical Outcomes of Image Guided Adaptive Hypofractionated Weekly Radiation Therapy for Bladder Cancer in Patients Unsuitable for Radical Treatment. Int J Radiat Oncol Biol Phys 2017; 98:115-122. [PMID: 28586948 PMCID: PMC5392498 DOI: 10.1016/j.ijrobp.2017.01.239] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/23/2017] [Accepted: 01/31/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE AND OBJECTIVES We report on the clinical outcomes of a phase 2 study assessing image guided hypofractionated weekly radiation therapy in bladder cancer patients unsuitable for radical treatment. METHODS AND MATERIALS Fifty-five patients with T2-T4aNx-2M0-1 bladder cancer not suitable for cystectomy or daily radiation therapy treatment were recruited. A "plan of the day" radiation therapy approach was used, treating the whole (empty) bladder to 36 Gy in 6 weekly fractions. Acute toxicity was assessed weekly during radiation therapy, at 6 and 12 weeks using the Common Terminology Criteria for Adverse Events version 3.0. Late toxicity was assessed at 6 months and 12 months using Radiation Therapy Oncology Group grading. Cystoscopy was used to assess local control at 3 months. Cumulative incidence function was used to determine local progression at 1 at 2 years. Death without local progression was treated as a competing risk. Overall survival was estimated using the Kaplan-Meier method. RESULTS Median age was 86 years (range, 68-97 years). Eighty-seven percent of patients completed their prescribed course of radiation therapy. Genitourinary and gastrointestinal grade 3 acute toxicity was seen in 18% (10/55) and 4% (2/55) of patients, respectively. No grade 4 genitourinary or gastrointestinal toxicity was seen. Grade ≥3 late toxicity (any) at 6 and 12 months was seen in 6.5% (2/31) and 4.3% (1/23) of patients, respectively. Local control after radiation therapy was 92% of assessed patients (60% total population). Cumulative incidence of local progression at 1 year and 2 years for all patients was 7% (95% confidence interval [CI] 2%-17%) and 17% (95% CI 8%-29%), respectively. Overall survival at 1 year was 63% (95% CI 48%-74%). CONCLUSION Hypofractionated radiation therapy delivered weekly with a plan of the day approach offers good local control with acceptable toxicity in a patient population not suitable for radical bladder treatment.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Cystectomy
- Disease Progression
- Female
- Gastrointestinal Diseases/etiology
- Humans
- Kaplan-Meier Estimate
- Male
- Prospective Studies
- Radiation Dose Hypofractionation
- Radiation Injuries/pathology
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Image-Guided/adverse effects
- Radiotherapy, Image-Guided/methods
- Time Factors
- Treatment Outcome
- Urinary Bladder/radiation effects
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/radiotherapy
- Urination Disorders/etiology
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Affiliation(s)
- Shaista Hafeez
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey.
| | | | | | - Helen McNair
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - Karole Warren-Oseni
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - Kelly Jones
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | | | | | | | - Karen Thomas
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - Vibeke Hansen
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - David Dearnaley
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - Alan Horwich
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - Robert Huddart
- The Institute of Cancer Research, London; The Royal Marsden NHS Foundation Trust, Sutton, Surrey
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Bachir BG, Souhami L, Mansure JJ, Cury F, Vanhuyse M, Brimo F, Aprikian AG, Tanguay S, Sturgeon J, Kassouf W. Phase I Clinical Trial of Everolimus Combined with Trimodality Therapy in Patients with Muscle-Invasive Bladder Cancer. Bladder Cancer 2017; 3:105-112. [PMID: 28516155 PMCID: PMC5409045 DOI: 10.3233/blc-160090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Local control following trimodality therapy (TMT) for muscle-invasive bladder cancer (MIBC) requires further optimization. Objective: Evaluating the biologic endpoint, feasibility, and toxicity of integrating everolimus to TMT in patients with MIBC. Methods: This was a phase I trial in patients with MIBC who were not surgical candidates or who refused cystectomy. Following maximal transurethral tumor resection, patients were treated by radiotherapy (50 Gy/20 fractions), gemcitabine (100 mg/m2/weekly) and escalating doses of everolimus (2.5–5.0 mg/day). Everolimus was given daily for one month prior to radiation, during treatment, and one month post-radiation. Toxicity assessment followed the Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Criteria. Biologic endpoint with downregulation of phospho-S6 (pS6) was assessed using immunohistochemistry. Local response was evaluated with imaging and bladder biopsy post-therapy. Results: 10 patients were recruited; 8 males, 2 females. Median age was 78 years (range: 63–85). Four patients entered everolimus 2.5 mg cohort. Six other patients entered everolimus 5.0 mg cohort. Toxicities were encountered in 2 patients (Grade I), 6 patients (Grade II), 9 patients (Grade III) and 1 patient (Grade IV), with some experiencing more than one toxicity. Most Grade III and IV toxicities were encountered from everolimus alone prior to combination testing. Trial was terminated early due to toxicity. Interestingly, 6/10 patients (60%) achieved a complete response with negative post-treatment biopsies. Significant decrease of pS6 was demonstrated post-therapy (p = 0.03). Conclusions: Although combining everolimus with TMT achieved a biological endpoint and complete response in a significant number of patients with MIBC and negative prognostic factors, it was associated with unacceptable increased toxicity.
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Affiliation(s)
- Bassel G Bachir
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Luis Souhami
- Division of Oncology, Division of Radiation Oncology, McGill University Health Center, Montreal, QC, Canada
| | - Jose João Mansure
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Fabio Cury
- Division of Oncology, Division of Radiation Oncology, McGill University Health Center, Montreal, QC, Canada
| | - Marie Vanhuyse
- Department of Medical Oncology, McGill University Health Center, Montreal, QC, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center, Montreal, QC, Canada
| | - Armen G Aprikian
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Simon Tanguay
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
| | - Jeremy Sturgeon
- Department of Medical Oncology, McGill University Health Center, Montreal, QC, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
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Michaelson MD, Hu C, Pham HT, Dahl DM, Lee-Wu C, Swanson GP, Vuky J, Lee RJ, Souhami L, Chang B, George A, Sandler H, Shipley W. A Phase 1/2 Trial of a Combination of Paclitaxel and Trastuzumab With Daily Irradiation or Paclitaxel Alone With Daily Irradiation After Transurethral Surgery for Noncystectomy Candidates With Muscle-Invasive Bladder Cancer (Trial NRG Oncology RTOG 0524). Int J Radiat Oncol Biol Phys 2016; 97:995-1001. [PMID: 28333021 DOI: 10.1016/j.ijrobp.2016.12.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/23/2016] [Accepted: 12/13/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE Bladder preservation therapy is an effective treatment for muscle-invasive urothelial carcinoma (UC). In this study we treated noncystectomy candidates with daily radiation and weekly paclitaxel for 7 weeks. Patients whose tumors showed her2/neu overexpression were additionally treated with weekly trastuzumab. METHODS AND MATERIALS Sixty-eight evaluable patients were treated with radiation therapy and either paclitaxel + trastuzumab (group 1) or paclitaxel alone (group 2). Groups were assigned on the basis of her2/neu immunohistochemistry results. Patients received 1.8-Gy fractions to a total dose of 64.8 Gy. The primary endpoint of the study was treatment-related toxicity, and secondary endpoints included complete response (CR) rate, protocol completion rate, and survival. RESULTS A total of 20 evaluable patients were treated in group 1 and 46 patients in group 2. Acute treatment-related adverse events (AEs) were observed in 7 of 20 patients in group 1 (35%) and 14 of 46 patients in group 2 (30.4%). Protocol therapy was completed by 60% (group 1) and 74% (group 2) of patients. Most incompletions were due to toxicity, and the majority of AEs were gastrointestinal, including 1 grade 5 AE (group 1). Two other deaths (both in group 2) were unrelated to protocol therapy. No unexpected cardiac, hematologic, or other toxicities were observed. The CR rate at 1 year was 72% for group 1 and 68% for group 2. CONCLUSIONS In patients with muscle-invasive UC who are not candidates for cystectomy, daily radiation combined with paclitaxel is an effective treatment strategy with a high completion rate and moderate toxicity. In patients with her2/neu-positive tumors, a group generally considered to have worse outcomes, the addition of trastuzumab appears to result in comparable efficacy and toxicity. Further biomarker-driven trials should be undertaken in advancing treatment of this challenging disease.
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Affiliation(s)
- M Dror Michaelson
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania; Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Douglas M Dahl
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Chin Lee-Wu
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | | | | | | | | | - Brian Chang
- Parkview Cancer Center, Parkview Hospital, Fort Wayne, Indiana
| | - Asha George
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | | | - William Shipley
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
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Soria F, Moschini M, Korn S, Shariat SF. How to optimally manage elderly bladder cancer patients? Transl Androl Urol 2016; 5:683-691. [PMID: 27785425 PMCID: PMC5071194 DOI: 10.21037/tau.2016.04.08] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Bladder cancer (BCa) is a disease of the elderly and as the population is aging, BCa will become an even bigger public health challenge in the future. Nowadays the correct management of BCa in the elderly remains controversial. The purpose of this article was to review the previous literature to summarize the current knowledge. Using Medline, a non-systematic review was performed including articles between January 2000 and February 2016 in order to describe the management of BCa in the elderly in all its aspects. English language original articles, reviews and editorials were selected based on their clinical relevance. In the literature, the definition of elderly is variable and based on chronological, not biological, age. BCa seems to be more aggressive in the elderly. The management of non-muscle invasive bladder cancer (NMIBC) does not strongly differ from younger patients, except for the role of adjuvant immunotherapy. In patients with muscle invasive bladder cancer (MIBC) the role of a multidisciplinary geriatric evaluation is potentially beneficial. The curative treatment in MIBC remains radical cystectomy (RC) and elderly patients should not be withheld a potentially life-saving intervention only based on chronological age. Patients unsuitable to a major surgical approach may be eligible for bladder-sparing techniques. Geriatric assessment could help identify the frail elderly and customize their perioperative care (i.e., pre and re habilitation). In conclusion the treatment of BCa in the elderly has to be patient-centered and focused on biological age and functional reserves.
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Affiliation(s)
- Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; ; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10126 Turin, Italy
| | - Marco Moschini
- Department of Urology, Medical University of Vienna, Vienna, Austria; ; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Stephan Korn
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; ; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; ; Department of Urology, Weill Cornell Medical College, New York, USA
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Bamias A, Tsantoulis P, Zilli T, Papatsoris A, Caparrotti F, Kyratsas C, Tzannis K, Stravodimos K, Chrisofos M, Wirth GJ, Skolarikos A, Mitropoulos D, Constantinides CA, Deliveliotis C, Iselin CE, Miralbell R, Dietrich P, Dimopoulos MA. Outcome of patients with nonmetastatic muscle-invasive bladder cancer not undergoing cystectomy after treatment with noncisplatin-based chemotherapy and/or radiotherapy: a retrospective analysis. Cancer Med 2016; 5:1098-107. [PMID: 27004619 PMCID: PMC4924368 DOI: 10.1002/cam4.685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
Transurethral resection of bladder tumor (TURBT), radiotherapy, chemotherapy, or combinations can be used in patients with muscle-invasive bladder cancer (MIBC) not undergoing cystectomy. Nevertheless, unfitness for cystectomy is frequently associated with unfitness for other therapeutic modalities. We report the outcome of patients with MIBC who did not undergo cystectomy and did not receive cisplatin-based chemotherapy. Selection criteria for the study were nonmetastatic MIBC, no cystectomy, no cisplatin-based chemotherapy. Chemotherapy and/or radiotherapy should have been used aside from TURBT. Forty-nine patients (median age 79), managed between April 2001 and January 2012, were included in this analysis. Median Charlson Comorbidity Index was 5, while 76% were unfit for cisplatin. Treatment included radiotherapy (n = 7), carboplatin-based chemotherapy (n = 25), carboplatin-based chemotherapy followed by radiotherapy (n = 10), and radiochemotherapy (n = 7). Five-year event-free rate was 26% (standard error [SE] = 7) for overall survival, 23% (SE = 7) for progression-free survival, and 30 (SE = 8) for cancer-specific survival (CSS). Patients who were treated with combination of radiotherapy and chemotherapy had significantly longer CSS compared to those treated with radiotherapy or chemotherapy only (5-year CSS rate: 16% [SE 8] vs. 63% [SE 15], P = 0.053). Unfit-for-cystectomy patients frequently receive suboptimal nonsurgical treatment. Their outcome was poor. Combining chemotherapy with radiotherapy produced better outcomes and should be prospectively evaluated.
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Affiliation(s)
- Aristotle Bamias
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- Department of Clinical TherapeuticsMedical SchoolAthens UniversityAthensGreece
| | - Petros Tsantoulis
- Department of Oncology and Centre de Recherche Clinique Dubois FerrariGeneva University HospitalGenevaSwitzerland
| | - Thomas Zilli
- Department of Radiation OncologyGeneva University HospitalGenevaSwitzerland
| | - Athanasios Papatsoris
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 2 Department of UrologyUniversity of AthensAthensGreece
| | | | - Christos Kyratsas
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 2 Department of UrologyUniversity of AthensAthensGreece
| | - Kimon Tzannis
- Department of Clinical TherapeuticsMedical SchoolAthens UniversityAthensGreece
| | - Kostas Stravodimos
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 1 Department of UrologyUniversity of AthensAthensGreece
| | - Michael Chrisofos
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 2 Department of UrologyUniversity of AthensAthensGreece
| | - Gregory J. Wirth
- Department of Urology DepartmentGeneva University HospitalGenevaSwitzerland
| | - Andreas Skolarikos
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 2 Department of UrologyUniversity of AthensAthensGreece
| | - Dionysios Mitropoulos
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 1 Department of UrologyUniversity of AthensAthensGreece
| | | | - Charalambos Deliveliotis
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- 2 Department of UrologyUniversity of AthensAthensGreece
| | | | - Raymond Miralbell
- Department of Radiation OncologyGeneva University HospitalGenevaSwitzerland
| | - Pierre‐Yves Dietrich
- Department of Oncology and Centre de Recherche Clinique Dubois FerrariGeneva University HospitalGenevaSwitzerland
| | - Meletios A. Dimopoulos
- Hellenic Genito‐Urinary Cancer GroupAthensGreece
- Department of Clinical TherapeuticsMedical SchoolAthens UniversityAthensGreece
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Trimodal therapy for invasive bladder cancer: is it really equal to radical cystectomy? Curr Opin Urol 2016; 25:476-82. [PMID: 26125510 DOI: 10.1097/mou.0000000000000203] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Trimodal therapy (TMT) is considered the most effective bladder-sparing approach for muscle-invasive urothelial carcinoma of the bladder (MIBC) and an alternative to radical cystectomy. The purpose of this article was to review and summarize the current knowledge on the equivalence of TMT and radical cystectomy based on the recent literature. RECENT FINDINGS TMT consists of a maximal transuretral resection of the bladder, followed by a concurrent radiotherapy and chemotherapy, limiting salvage radical cystectomy to nonresponder tumors or muscle-invasive recurrence. In large population studies, less than 6% of the patients with nonmetastatic MIBC receive a chemoradiation therapy and this rate is stable. A growing body of evidence exists that TMT provides good oncologic outcomes with low morbidity when compared with radical cystectomy. TMT requires, however, a close follow-up because of the high risk of local recurrence and salvage radical cystectomy in up to 30% of the patients. Salvage radical cystectomy can be performed with adequate results but does not offer the same opportunity of reconstruction and functional outcomes than primary radical cystectomy. SUMMARY Although radical cystectomy is still the treatment of reference for most of the patients with localized MIBC, TMT represents a reasonable alternative in highly selected patients. Any firm conclusion on the equivalence or superiority of one treatment to the other is still limited by the lack of randomized controlled trials and the heterogeneity of the available literature. Future studies and multidisciplinary approach are mandatory to optimize the patient selection and regimen of TMT.
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Patterns of Failure After Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 94:1031-9. [DOI: 10.1016/j.ijrobp.2015.10.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/16/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
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Bellmunt J, Mottet N, De Santis M. Urothelial carcinoma management in elderly or unfit patients. EJC Suppl 2016; 14:1-20. [PMID: 27358584 PMCID: PMC4917740 DOI: 10.1016/j.ejcsup.2016.01.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Joaquim Bellmunt
- Bladder Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicolas Mottet
- Department of Urology, CHU de Saint-Etienne, University Jean Monnet, St Etienne, France
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Jensen TK, Jensen NV, Jørgensen SM, Clark P, Lund L. Trends in cancer of the urinary bladder and urinary tract in elderly in Denmark, 2008-2012. Acta Oncol 2016; 55 Suppl 1:85-90. [PMID: 26784363 DOI: 10.3109/0284186x.2015.1115122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to examine the trends in incidence, mortality, survival, and prevalence of cancers of the urinary bladder and urinary tract in Denmark from 1980 to 2012 with particular focus on elderly patients over age 70 years. DESIGN Cancer of the urinary bladder and urinary tract was defined as ICD-10 codes C67.9, D09.0, D41.4. Data were derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry. RESULTS The average annual number of bladder cancers increased from 1478 to 1810 (22%) from 1980 to 2012, with close to 60% occurring in the elderly population. The incidence rates were 7-10 times higher in persons aged 70 years or more compared with younger persons. Mortality rates were decreasing with time in all age groups but 90+-year-old men. The one- and five-year relative survival improved significantly with time for all age groups both in men and women. The prevalence increased two times from 6014 in 1980 to 12 359 in 2012 among men and from 1974 to 4454 among women. There was a relatively higher proportional increase in prevalence among elderly men compared to younger patients. CONCLUSION More prospective data are needed, preferably as randomized clinical trials, for determining the influence of age on the decisions of the surgical approach as well as chemo/radiotherapy for the elderly patients with urothelial cancers compared to younger patients.
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Affiliation(s)
- Thor Knak Jensen
- a Department of Urology , Odense University Hospital , Odense , Denmark
| | - Niels Viggo Jensen
- b Department of Oncology , Odense University Hospital , Odense , Denmark
| | | | - Peter Clark
- c Clinical Institute, University of Southern Denmark , Odense , Denmark
- d Department of Urology , Vanderbilt University Hospital , Tennessee , USA
| | - Lars Lund
- a Department of Urology , Odense University Hospital , Odense , Denmark
- c Clinical Institute, University of Southern Denmark , Odense , Denmark
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Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for Urinary Bladder Cancer: A Prospective Study. Int J Radiat Oncol Biol Phys 2016; 94:60-66. [DOI: 10.1016/j.ijrobp.2015.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/17/2022]
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Whalley D, Caine H, McCloud P, Guo L, Kneebone A, Eade T. Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer. Radiat Oncol 2015; 10:205. [PMID: 26407726 PMCID: PMC4583158 DOI: 10.1186/s13014-015-0499-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 09/03/2015] [Indexed: 01/06/2023] Open
Abstract
AIM To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. METHODS Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment. RESULTS The median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed. Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone. CONCLUSION IG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity.
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Affiliation(s)
- D Whalley
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
| | - H Caine
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
| | - P McCloud
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia. .,McCloud Consulting Group, 7-9 Merriwa Street, Gordon, NSW, 2072, Australia.
| | - L Guo
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
| | - A Kneebone
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia. .,McCloud Consulting Group, 7-9 Merriwa Street, Gordon, NSW, 2072, Australia.
| | - T Eade
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia. .,Northern Clinical School, University of Sydney, Camperdown, NSW, 2050, Australia.
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47
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A review of the 2014 English Language publications pertinent to the treatment of invasive bladder cancer by radiotherapy. Curr Opin Support Palliat Care 2015; 9:245-8. [DOI: 10.1097/spc.0000000000000151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gomes CM, Nunes RV, Tse V. Pelvic Irradiation and Its Effects on the Lower Urinary Tract: a Literature Review. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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Canyilmaz E, Yoney A, Serdar L, Uslu GH, Aynaci O, Haciislamoglu E, Yavuz MN. Long-term results of a concomitant boost radiotherapy technique for elderly patients with muscle-ınvasive bladder cancer. J Geriatr Oncol 2015; 6:316-23. [PMID: 25959052 DOI: 10.1016/j.jgo.2015.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/25/2015] [Accepted: 04/21/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the long-term clinical efficacy and toxicity of concomitant boost radiotherapy (CBRT) in elderly patients with invasive bladder cancer. METHODS AND MATERIALS Elderly patients (n=188; mean 75-year-old, range 70-91 years; 88.3% male/11.7% female) with T1-T4a bladder carcinoma were irradiated with CBRT. A total of 24 (12.8%) patients were diagnosed at stage T1, 117 (62.2%) were at stage T2, 28 (14.9%) at were stage T3a, 14 (7.4%) were stage T3b, and 5 (2.7%) were stage T4a. A dose of 45Gy in 1.8Gy fractions was administered to the whole pelvis 5 days/week over 5 weeks. A concomitant boost limited to the bladder tumor area plus margin or whole bladder of 22.5Gy in 1.5Gy fractions was administered from weeks 3×5. Thus, irradiation totalled 67.5Gy over 5 weeks. The interfraction interval was ≥6h/treatment day. We assessed prognostic factors for overall survival (OS), cause-specific survival (CSS) and relapse-free survival (RFS). RESULTS Median follow-up was 46.2 months (range 4.7-155.7 months). Median overall survival was 27 months (95% CI:21-33 months). In this study, 146 (77.7%) patients had complete response, 39 (20.7%) had residual disease and 4 (1.6%) had progressive disease. The mean 3-, 5- and 10-year OS rates were respectively 41.2% (S.E.±0.036), 29% (S.E.±0.034), and 13.8% (S.E.±0.031). Significant prognostic factors for OS and CSS, by multivariate analysis, were tumor T-stage and urothelial obstruction. CONCLUSION This CBRT protocol provided excellent results with a high complete response rate and good tolerance. This approach may therefore be particularly appropriate for elderly patients with invasive bladder cancer.
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Affiliation(s)
- Emine Canyilmaz
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Adnan Yoney
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Lasif Serdar
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Gonca Hanedan Uslu
- Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey.
| | - Ozlem Aynaci
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Emel Haciislamoglu
- Department of Radiation Oncology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Melek Nur Yavuz
- Department of Radiation Oncology, Faculty of Medicine, Akdeniz University, Antalya,Turkey.
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Premo C, Apolo AB, Agarwal PK, Citrin D. Trimodality therapy in bladder cancer: who, what, and when? Urol Clin North Am 2015; 42:169-80, vii. [PMID: 25882559 PMCID: PMC4465095 DOI: 10.1016/j.ucl.2015.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Radical cystectomy is a standard treatment of nonmetastatic, muscle-invasive bladder cancer. Treatment with trimodality therapy consisting of maximal transurethral resection of the bladder tumor followed by concurrent chemotherapy and radiation has emerged as a method to preserve the native bladder in highly motivated patients. Several factors can affect the likelihood of long-term bladder preservation after trimodality therapy and therefore should be taken into account when selecting patients. New radiation techniques such as intensity modulated radiation therapy and image-guided radiation therapy may decrease the toxicity of radiotherapy in this setting. Novel chemotherapy regimens may improve response rates and minimize toxicity.
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Affiliation(s)
- Christopher Premo
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 CRC, B2-3500, Bethesda, MD 20892, , Phone: (301) 496-5457, Fax (301) 480-5439
| | - Andrea B. Apolo
- Bladder Cancer Section, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr.12N226, MSC 1906, Bethesda, MD 20892, Tel: 301-451-1984, Fax: 301-402-0172,
| | - Piyush K. Agarwal
- Bladder Cancer Section, Urologic Oncology Branch, National Cancer Institute, NIH, Building 10, Room 2W-5940, Bethesda, MD 20892-1210, Office: 301-496-6353, Fax: 301-480-5626,
| | - Deborah Citrin
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, 10 CRC, B2-3500, Bethesda, MD 20892, , Phone: (301) 496-5457, Fax (301) 480-5439
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