Adjuvant and Neoadjuvant Radiation Therapy for Locally Advanced Bladder Cancer.

Published on Jun 1, 2021in Clinical Oncology3.113
· DOI :10.1016/J.CLON.2021.03.020
Brian C. Baumann16
Estimated H-index: 16
(UPenn: University of Pennsylvania),
Mohamed S. Zaghloul18
Estimated H-index: 18
+ 1 AuthorsVedang Murthy26
Estimated H-index: 26
Source
Abstract
Abstract Local-regional failure for patients with ≥pT3 urothelial carcinoma after radical cystectomy is a significant clinical challenge. Prospective randomised trials have failed to show that chemotherapy reduces the risk of local-regional recurrences. Salvage treatment for local failures is difficult and often unsuccessful. There is promising evidence, particularly from a recent Egyptian National Cancer Institute trial, that radiation therapy plus chemotherapy can significantly reduce local recurrences compared with chemotherapy alone, and that this improvement in local-regional control may translate to meaningful improvements in disease-free and overall survival with acceptable toxicity. In light of the high rates of local failure following cystectomy for locally advanced disease and the progress that has been made in identifying patients at high risk of failure and the patterns of failure in the pelvis, the National Comprehensive Cancer Network guidelines were revised to include postoperative radiotherapy as an option to consider for patients with ≥pT3 disease. Here we review the problem of local-regional failure after cystectomy, identify patients who would probably benefit from adjuvant radiotherapy, review the patterns of pelvic failure after cystectomy, discuss technical details of radiation treatment and review the modern literature on this topic. Adjuvant radiotherapy should be considered as a treatment option for patients with locally advanced disease, especially those with positive margins or squamous cell carcinoma.
References45
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#1V. Murthy (HBNI: Homi Bhabha National Institute)H-Index: 5
#1Vedang Murthy (HBNI: Homi Bhabha National Institute)H-Index: 26
Last. Rahul Krishnatry (HBNI: Homi Bhabha National Institute)H-Index: 13
view all 17 authors...
Abstract Purpose We report the patterns of locoregional recurrence (LRR) in muscle invasive bladder cancer (MIBC), and propose a risk stratification to predict LRR for optimizing the indication for adjuvant radiotherapy. Materials and Methods The study included patients of urothelial MIBC who underwent radical cystectomy with standard perioperative chemotherapy between 2013 and 2019. Recurrences were classified into local and/or cystectomy bed, regional, systemic, or mixed. For risk stratificati...
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#1Mohamed Saddik Zaghloul (Cairo University)H-Index: 4
#1Mohamed S. Zaghloul (Cairo University)H-Index: 18
Last. Brian C. Baumann (WashU: Washington University in St. Louis)H-Index: 16
view all 4 authors...
Urinary schistosomiasis and its severe complications, mainly bladder cancer, are scarce in non-endemic areas. The deficiency in knowledge and clinical experience of schistosomiasis may lead to inadequate management. Highlighting these topics may be of value, especially with the increased immigration from endemic low-/middle-income countries (LMIC) to non-endemic high-income countries (HIC). Schistosomiasis is a parasitic infection endemic in many low- and middle-income countries. It can affect v...
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#1Brian C. Baumann (Leonard Davis Institute of Health Economics)H-Index: 16
#2Nandita Mitra (Leonard Davis Institute of Health Economics)H-Index: 3
Last. James M. Metz (UPenn: University of Pennsylvania)H-Index: 5
view all 13 authors...
Importance Concurrent chemoradiotherapy is the standard-of-care curative treatment for many cancers but is associated with substantial morbidity. Concurrent chemoradiotherapy administered with proton therapy might reduce toxicity and achieve comparable cancer control outcomes compared with conventional photon radiotherapy by reducing the radiation dose to normal tissues. Objective To assess whether proton therapy in the setting of concurrent chemoradiotherapy is associated with fewer 90-day unpl...
17 CitationsSource
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#1Benjamin W. Fischer-Valuck (Emory University)H-Index: 16
#2Jeff M. Michalski (WashU: Washington University in St. Louis)H-Index: 73
Last. Brian C. Baumann (WashU: Washington University in St. Louis)H-Index: 16
view all 21 authors...
BACKGROUND: Local-regional failure (LF) for locally advanced bladder cancer (LABC) after radical cystectomy (RC) is common even with chemotherapy and is associated with high morbidity/mortality. Postoperative radiotherapy (PORT) can reduce LF and may enhance overall survival (OS) but has no defined role. We hypothesized that the addition of PORT would improve OS in LABC in a large nationwide oncology database. METHODS: We identified ≥ pT3pN0-3M0 LABC patients in the National Cancer Database diag...
4 CitationsSource
#1Mohamed S. ZaghloulH-Index: 18
Last. Brian C. Baumann (WashU: Washington University in St. Louis)H-Index: 16
view all 9 authors...
4507Background: Some chemotherapy-naive patients with locally advanced bladder cancer (LABC) after radical cystectomy (RC) are sufficiently de-conditioned that they are not candidates for adjuvant ...
1 CitationsSource
#1Mohamed S. ZaghloulH-Index: 18
Last. Brian C. Baumann (WashU: Washington University in St. Louis)H-Index: 16
view all 7 authors...
351Background: The role of post-operative chemotherapy after radical cystectomy (RC) is not well-defined. While some retrospective studies have shown a benefit, trials have been under-powered. In a...
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#1Paul SargosH-Index: 18
#2Brian C. Baumann (WashU: Washington University in St. Louis)H-Index: 16
Last. Stéphane LarréH-Index: 15
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Abstract Background Radical cystectomy (RC) associated with pelvic lymph node dissection (PLND) is the most common local therapy in the management of non-metastatic muscle invasive bladder cancer (MIBC). Loco-regional recurrence (LRR), however, remains a common and important therapeutic challenge associated with poor oncologic outcomes. We aimed to systematically review evidence regarding factors associated with LRR and to propose a framework for adjuvant radiotherapy (RT) in patients with MIBC....
9 CitationsSource
#1Yubing Tong (UPenn: University of Pennsylvania)H-Index: 11
#2Jayaram K. Udupa (UPenn: University of Pennsylvania)H-Index: 78
Last. Drew A. Torigian (UPenn: University of Pennsylvania)H-Index: 53
view all 10 authors...
Abstract Background Current clinical staging methods are unable to accurately define the extent of invasion of localized bladder cancer, which affects the proper use of systemic therapy, surgery, and radiation. Our purpose was to test a novel radiomics approach to identify optimal imaging biomarkers from T2-weighted magnetic resonance imaging (MRI) scans that accurately classify localized bladder cancer into 2 tumor stage groups (≤T2 vs >T2) at both the patient level and within bladder subsector...
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