Muscle-invasive bladder cancer treated with TURB followed by concomitant boost with small reduction of radiotherapy field with or without of chemotherapy
Abstract
Aim
To evaluate the clinical outcome and toxicity of the treatment of muscle-invasive bladder cancer (MIBC) that combined transurethral resection of bladder tumor (TURB) with “concomitant boost” radiotherapy delivered over a shortened overall treatment time of 5 weeks, with or without concurrent chemotherapy.
Background
Local control of MIBC by bladder-sparing approach is unsatisfactory. In order to improve the effectiveness of radiotherapy, we have designed a protocol that combines TURB with a non-conventionally fractionated radiotherapy “concomitant boost”.
Materials and methods
Between 2004 and 2010, 73 patients with MIBC cT2-4aN0M0, were treated with “concomitant boost” radiotherapy. The whole bladder with a 2–3[[ce:hsp sp="0.25"/]]cm margin was irradiated with fractions of 1.8[[ce:hsp sp="0.25"/]]Gy to a dose of 45[[ce:hsp sp="0.25"/]]Gy, with a “concomitant boost” to the bladder with 1–1.5[[ce:hsp sp="0.25"/]]cm margin, during the last two weeks of treatment, as a second fraction of 1.5[[ce:hsp sp="0.25"/]]Gy, to a total dose of 60[[ce:hsp sp="0.25"/]]Gy. Radiochemotherapy using mostly cisplatin was delivered in 42/73(58%) patients, 31/73(42%) patients received radiotherapy alone.
Results
Acute genitourinary toxicity of G3 was scored in 3/73(4%) patients. Late gastrointestinal toxicity higher than G2 and genitourinary higher than G3 were not reported. Complete remission was achieved in 48/73(66%), partial remission in 17/73(23%), and stabilization disease in 8/73(11%) patients. Three- and five-year overall, disease specific and invasive locoregional disease-free survival rates were 65% and 52%, 70% and 59%, 52% and 43%, respectively.
Conclusions
An organ-sparing approach using TURB followed by radio(chemo)therapy with “concomitant boost” in patients with MIBC allows to obtain long-term survival with acceptable toxicity.
Keywords: Muscle-invasive bladder cancerRadical conservative treatmentRadiotherapyConcomitant boost