Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for Urinary Bladder Cancer: A Prospective Study
| Autor: | Umesh Mahantshetty, Gagan Prakash, Vedang Murthy, Nikhil Kalyani, Shyamkishore Shrivastava, Kumar Prabhash, Ganesh Bakshi, Amit Joshi, Renuka Masodkar, Sujata Ghonge |
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| Rok vydání: | 2015 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Time Factors medicine.medical_treatment Urology Antineoplastic Agents Disease-Free Survival 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Carcinoma medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Radiation treatment planning Prospective cohort study Neoadjuvant therapy Aged Chemotherapy Carcinoma Transitional Cell Radiation Bladder cancer Lymphatic Irradiation business.industry Induction chemotherapy Radiotherapy Dosage Induction Chemotherapy Middle Aged medicine.disease Neoadjuvant Therapy Surgery Radiation therapy Treatment Outcome Oncology Urinary Bladder Neoplasms 030220 oncology & carcinogenesis Feasibility Studies Female Radiotherapy Intensity-Modulated business Organ Sparing Treatments Follow-Up Studies Radiotherapy Image-Guided |
| Zdroj: | International journal of radiation oncology, biology, physics. 94(1) |
| ISSN: | 1879-355X |
| Popis: | Purpose The purpose of this study was to assess feasibility, clinical outcomes, and toxicity in patients with bladder cancer treated with adaptive, image guided radiation therapy (IGRT) for bladder preservation as a part of trimodality treatment. The role of dose escalation was also studied. Methods and Materials Forty-four patients with localized bladder cancer were enrolled in a prospective study. They underwent maximal safe resection of bladder tumor and concurrent platinum-based chemotherapy. Patients with large tumors were offered induction chemotherapy. Radiation therapy planning was done using either 3 (n=34) or 6 (n=10) concentrically grown planning target volumes (PTV). Patients received 64 Gy in 32 fractions to the whole bladder and 55 Gy to the pelvic nodes and, if appropriate, a simultaneous integrated boost to the tumor bed to 68 Gy (equivalent dose for 2-Gy fractions assuming α/β of 10 [EQD2] 10 = 68.7 Gy). Daily megavoltage (MV) imaging helped to choose the most appropriate PTV encompassing bladder for the particular day (using plan-of-the-day approach). Results Most patients (88%) had T2 disease. Sixteen patients (36%) received neoadjuvant chemotherapy. A majority of the patients (73%) received prophylactic nodal irradiation, whereas 55% of the patients received escalated dose to the tumor bed. With a median follow-up of 30 months, the 3-year locoregional control (LRC), disease-free survival, and overall survival (OS) were 78%, 66%, and 67%, respectively. The bladder preservation rate was 83%. LRC (87% vs 68%, respectively, P =.748) and OS (74% vs 60%, respectively, P =.36) rates were better in patients receiving dose escalation. Instances of acute and late Radiation Therapy Oncology Group (RTOG) grade 3 genitourinary toxicity was seen in 5 (11%) and 2 (4%) patients, respectively. There was no acute or late RTOG grade 3 or higher gastrointestinal toxicity. Conclusions Adaptive IGRT using plan-of-the-day approach for bladder preservation is clinically feasible, with good oncological outcomes and low rates of acute and late toxicities. Dose escalation is safe and possibly improves outcomes in bladder preservation. |
| Databáze: | OpenAIRE |
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