A Pilot Study of Radiotherapy and Local Hyperthermia in Elderly Patients With Muscle-Invasive Bladder Cancers Unfit for Definitive Surgery or Chemoradiotherapy.

Niloy Ranjan Datta,Emanuel Stutz,Brigitte Eberle,Susanne Rogers,Olaf Timm,Emsad Puric,Andreas Meister,Dietmar Marder,Stephen Wyler,Stephan Bodis

doi:10.3389/fonc.2019.00889

Niloy Ranjan Datta, Emanuel Stutz + Show 8 more

Open Access

https://doi.org/10.3389/fonc.2019.00889

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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.

Highlights

Bladder cancer (BC) ranks globally as the ninth commonest cancer with an estimated 0.43 million new cases in 2012 [1]
This report is an analysis of the outcome of 16 patients with muscle invasive bladder cancers (MIBC) treated in this pilot study with HTRT
Neoadjuvant chemotherapy followed by radical cystectomy with bilateral pelvic lymph node dissection has been the standard therapeutic option in MIBC [5]

Summary

Introduction

Bladder cancer (BC) ranks globally as the ninth commonest cancer with an estimated 0.43 million new cases in 2012 [1]. Europe has the highest incidence of BC [2]. A similar trend is anticipated globally [4]. These factors compel the medical community to explore appropriate therapies in the geriatric population with cancer, where radical surgical approaches and intensive cytotoxic therapies may be associated with higher risks due to age-related comorbidities and poorer treatment compliance and acceptance. Neoadjuvant chemotherapy followed by radical cystectomy plus urinary diversion is regarded as a standard of care in muscle invasive bladder cancers (MIBC) [5], elderly patients with associated comorbidities are often deemed unfit to undergo such radical surgery [6, 7]. Radiation therapy (RT) alone for such patients has limited therapeutic benefit, the use of recent RT techniques using image guided intensity modulated RT has shown to achieve good local control with low toxicity [10,11,12,13]

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