Abstract
AimOur aim is to compare the toxicity, pelvic nodal relapse, and overall survival of whole bladder irradiation only to the standard technique of whole pelvis irradiation followed by bladder boost in patients with muscle-invasive bladder carcinoma undergoing bladder preservation protocol.Material and methodA total of 60 patients with transitional cell carcinoma, stage T2-3, N0, M0 bladder cancer were subjected to maximal transurethral resection bladder tumour (TURB). Then, the patients were randomised into two groups: group I (30 patients) to receive whole pelvis radiotherapy 44 Gy followed by 20 Gy bladder boost. While group II (30 patients) were randomised to receive whole bladder radiotherapy alone for a total dose of 64 Gy. In both groups, concomitant cisplatin and paclitaxel were given weekly throughout the whole course of radiotherapy where conventional 2 Gy/fraction were used. Additionally, four cycles of adjuvant cisplatin and paclitaxel were given after the end of the chemoradiotherapy induction course.ResultsThe first assessment after the induction chemoradiotherapy showed that complete response was achieved in 73.3% of patients in group I and 76.7% of the patients in group II. After a median follow-up of 2 years, regional relapse occurred in 7.1% of patients in group I and 10.3% in group II. (p = 1). Distant metastases were detected in 17.9% of patient in group I and 13.8% in group II (p = 0.73). The 2-year disease-free survival was 60% in group I and 63.3% in group II (p = 0.79). The whole 2-year overall survival was 75% in group I and 79.3% in group II (p = 0.689). Radiation gastrointestinal (GI) acute toxicity was higher in group I than in group II (p = 0.001), while late GI radiation toxicity was comparable in both groups.ConclusionTreating the bladder only, without elective pelvic nodal irradiation, did not compromise pelvic control rate, but significantly decreased the acute radiation toxicity.
Highlights
Bladder cancer ranks ninth in worldwide cancer incidence
The first assessment after the induction chemoradiotherapy showed that complete response was achieved in 73.3% of patients in group I and 76.7% of the patients in group II
Even the construction of a neobladder after cystecomy cannot substitute for the patient’s original bladder, owing to late complications. These include pyelonephritis, strictures, calculi, fistula formation, continence problems and the need for intermittent self-catheterisation, necessitating long-term follow-up in these patients [7]. Besides these several problematic complications of radical cystectomy, this surgery results in only 40–60% 5-year overall survival, and despite a high local control attained by this approach, 20–30% of patients may develop local relapse with or without metastatic spread [8]
Summary
Bladder cancer ranks ninth in worldwide cancer incidence. It is the seventh most common cancer in males and the 17th most common cancer in females [1]. Even the construction of a neobladder after cystecomy cannot substitute for the patient’s original bladder, owing to late complications These include pyelonephritis, strictures, calculi, fistula formation, continence problems and the need for intermittent self-catheterisation, necessitating long-term follow-up in these patients [7]. Besides these several problematic complications of radical cystectomy, this surgery results in only 40–60% 5-year overall survival, and despite a high local control attained by this approach, 20–30% of patients may develop local relapse with or without metastatic spread [8]. A study by Wright et al showed that an increased number of lymph nodes removed at the time of cystectomy was associated with improved survival in patients with lymph node-positive bladder cancer [22]
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