High-precision Bladder Cancer Irradiation in the Elderly: Clinical Results for a Plan-of-the-day Integrated Boost Technique with Image Guidance Using Lipiodol Markers.

Autor: Beulens AJW; Department of Urology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: alexander.beulens@catharinaziekenhuis.nl., van der Toorn PP; Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands., de Wildt MJ; Department of Urology, Catharina Hospital, Eindhoven, The Netherlands., Scheepens WA; Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.
Jazyk: angličtina
Zdroj: European urology oncology [Eur Urol Oncol] 2019 Feb; Vol. 2 (1), pp. 39-46. Date of Electronic Publication: 2018 Sep 07.
DOI: 10.1016/j.euo.2018.08.012
Abstrakt: Background: For most elderly patients with muscle-invasive bladder cancer (MIBC), surgery is not an option because of patient frailty. Conventional radiotherapy, with its high-dose irradiation of surrounding healthy tissues, remains the only curative treatment for this patient population.
Objective: To determine whether targeted radiotherapy with Lipiodol demarcation and plan-of-the-day integrated boost technique (LPOD) is a viable curative treatment for elderly patients with MIBC.
Design, Setting, and Participants: Between September 2008 and September 2016 all MIBC patients in our hospital were screened for eligibility. We included patients with localised, unifocal T2-T4N0M0 grade 2-3 MIBC. Patients with a tumour volume >50% of the bladder wall surface, previous pelvic radiotherapy, and unilateral or bilateral hip prostheses were excluded.
Intervention: Targeted radiotherapy using LPOD.
Outcome Measurements and Statistical Analysis: Overall survival, urothelial cell cancer-specific survival (UCCSS), disease recurrence, and Radiation Therapy Oncology Group (RTOG) toxicity were measured. Statistical analyses included independent-sample t tests, χ 2 tests, and Mann-Whitney U tests.
Results and Limitations: A total of 44 patients (median age 80 yr) were included. Over median follow-up of 38 mo, one patient ceased treatment and 23 patients died. LPOD resulted in a 11.4% chance of local recurrence, high 3-yr UCCSS of 77%, RTOG grade >3 toxicity of 2.3-12.9%, and 3-yr overall survival of 49%.
Conclusions: LPOD is a feasible first-line treatment option for older patients with limited-volume T2-T4N0M0 grade 2-3 MIBC.
Patient Summary: We looked at outcomes after targeted radiotherapy in elderly patients with muscle-invasive bladder cancer. We found that this treatment results in a low chance of disease recurrence with few toxicity complaints. We conclude that this treatment is a viable first-line treatment option for elderly patients.
(Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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