Abstract
ABSTRACTHypothesis:Endoclip can be used as fiducial marker in urology.Objective:To assess the feasibility, cost effectiveness and reliability of endoclips as novel fiducial markers in precision radiotherapy, as part of a trimodality bladder-preserving treatment (TBPT) of muscle-invasive bladder carcinoma.Materials and Methods:This retrospective study was performed at Weifang People's Hospital (Weifang, China) from January 2015 to June 2018. A total of 15 patients underwent TBPT. Endoclips were applied to healthy edges of the resected bladder wall as novel fiducial markers. Radio-sensitizing chemotherapy and routine precision radiotherapy were given. The number and position of the endoclips during radiotherapy sessions were monitored. Complications and tumor recurrence were analyzed.Results:The mean age (±standard deviation) of the patients was 67±10 years (range 46-79). There were 3 females and 12 males. Forty-nine endoclips were applied in all patients (3.3±0.8). The tumor was completely visibly resected in all patients. The number of endoclips remained the same through the planned last radiotherapy session (3.3±0.8), i.e., none were lost. All endoclips were removed after the last radiotherapy session. The average number of follow-up months was 38.9±13.2 (range 11-52). There were no procedure-related complications at discharge or follow-up. At one-year, overall recurrence-free survival was 93.3%. Two patients had recurrences at 18 months and 10 months after TBPT, respectively, and salvage radical cystectomy was performed with no further recurrences. Another patient died due to metastasis 9 months after the completion of therapy.Conclusions:Endoclips are reliable, safe and cost-effective as novel fiducial markers in precision-radiotherapy post-TBPT.
Highlights
MATERIALS AND METHODSBladder cancer is the 9th most common cancer worldwide, with an annual incidence of 430.000 cases [1]
Muscle-invasive bladder carcinoma accounts for 25% of all bladder cancers [5]
Fifteen patients diagnosed with T2N0M0 stage muscle-invasive bladder carcinoma were enrolled in the study
Summary
Bladder cancer is the 9th most common cancer worldwide, with an annual incidence of 430.000 cases [1] It is ranked 13th in terms of cancer-related mortality [1] and affects up to six times as many men as women [2, 3]. It is largely a disease of industrialized nations, and the age-standardized incidence is tjree times higher in developed countries compared to developing countries [4]. Radiotherapy is complicated by inter- and intra-fraction target motion, which can vary up to 3cm and is dependent on the location of the tumor in the bladder [8, 9]. Complete bladder treatment and large planning target volume margins, ranging from 15-20mm, are used as a precaution for the target motion as the standard of care [9]
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