1. Institute of Oncology “Ion Chiricuță”, Cluj, Romania
LATE OUTCOMES FOR CONCOMITANT RADIO-CHEMOTHERAPY FOR NONMETASTATIC MUSCLE INVASIVE BLADDER CANCER (April 2011 update) G. KACSÓ, Z. FEKETE, N. TODOR, O. VEREȘEZAN, C. CEBOTARU
Institute of Oncology “Ion Chiricuță”, Cluj, Romania
Purpose
Therapeutic Protocol
■ single institution analysis of long term outcomes of bladder sparing curative chemoradiation for muscle-invading transitional carcinoma of the bladder
Specific survival and tumor response
TURB or partial cystectomy
Gy/standard fractionation +
■ cT2 : Cisplatin 20mg/m2/day, D1-5/q21 – 2 cycles or
■ cT3-4a or cN+: Cisplatin 100mg/m2/ day/q21 – 2 cycles
Material & Methods
■ , 60 patients (53 men-88%)
■ cT2 (41.6%), cT3 (33.4%), cT4a (25 %); cN0 (71.6%) to cN2, M0
■ transitional cell carcinoma of the bladder (60% G3)
■ age < 80 (median 58 y, range y)
■ natural life expectancy at least 5 years
■ PS≤ 2
■ maximal tumor resection (TURB or partial cystectomy)
Clinical reevaluation (ultrasound + cystoscopy)
Specific survival and EBRT dose
Complete or partial response and refusal of a future salvage cystectomy
Complete or partial response or progression
Results
stop of chemoradiation
■ Follow-up: 99.9 months [ mo.]
■ 29 pts (48.3%) had their disease controlled (primarily or secondarily)
■ 24 pts had their disease controlled (primarily or secondarily) with intact bladder (40% of all patients)
■ 28 (46.7%) patients died of their disease, 3 (5%) deaths were related to treatment (mainly surgery) and 10 (16.7 %) were non-cancer deaths
■ Local relapse was the major cause of failure (45 %), alone or along regional or distant failure; some of them were probably new primary tumors
■ from 18 solely local relapses (representing 30% of all relapses) 14 (78%) were superficial, still allowing bladder preservation
■ Specific survival depended on tumor grade, response to chemoradiation and presence of hydronephrosis (HyN)
■ EBRT dose greater than 60 Gy was a statistically significant factor, negatively influencing survival at a median follow-up of 63 mo, but is not significant at 99.9 mo (probably due to small no. of pts.)
■ There was a tendency of increased survival inversely correlated with T stage and age, but these factors didn’t reach statistical significance
20 Gy boost +
3. cycle of Cisplatin
Histological reevaluation at 4-6 weeks
(ultrasound + cystoscopy with biopsies)
EBRT dose in different stages
Residual tumor
Salvage cystectomy
Complete response
Follow-up
Specific survival according to tumor grade
Specific survival and the presence of HyN
5 & 10 y SV: Overall and specific
Acute toxicity (CTC 3.0)
Conclusions
Late toxicity (CTC 3.0)
■ Chemoradiation is highly effective for muscle-invading bladder cancer with 40% cure rate with bladder preservation and 39% specific survival at 10 yrs
■ Acute and late toxicities are quite acceptable by keeping the total dose between 50 to 60 Gy with concurrent platinum compound.
Acute toxicity
G1-2
G3-4
Urinary
58.34 %
15 %
Upper digestive
56.67 %
5 %
Lower digestive
50 %
■ Urinary G3-4: 3 cases (5%) – gross hematuria
■ Digestive G3-4:
- 1 case of small bowel necrosis
- 1 case of sigmoid ulceration
■ OTHER: AML (8 ys after)- 1 case