The Use of External-beam Radiotherapy for Muscle-invasive Bladder Cancer in Elderly or Medically-fragile Patients

2017 ◽  
Vol 37 (10) ◽  
Keyword(s):  
Bladder Cancer ◽  
External Beam Radiotherapy ◽  
Invasive Bladder Cancer ◽  
External Beam ◽  
Medically Fragile ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

scholarly journals Increased utilization of external beam radiotherapy relative to cystectomy for localized, muscle-invasive bladder cancer: a SEER analysis

Bladder ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 34
Author(s):  
Tyler J. Wilhite ◽  
David Routman ◽  
Andrea L. Arnett ◽  
Amy E. Glasgow ◽  
Elizabeth B. Habermann ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
External Beam Radiotherapy ◽  
Invasive Bladder Cancer ◽  
External Beam ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Muscle-Invasive Bladder Cancer in Elderly-Unfit Patients with Concomitant Illness: Can a Curative Radiation Therapy be Delivered?

2002 ◽  
Vol 88 (5) ◽  
pp. 390-394 ◽  
Author(s):  
Anna Santacaterina ◽  
Nicola Settineri ◽  
Costantino De Renzis ◽  
Pasquale Frosina ◽  
Antonietta Brancati ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Elderly Patients ◽  
External Beam Radiotherapy ◽  
Palliative Radiotherapy ◽  
Invasive Bladder Cancer ◽  
Pelvic Irradiation ◽  
Muscle Invasive Bladder Cancer ◽  
Curative Radiotherapy ◽  
Unfit Patients ◽  
Muscle Invasive

Aims and background There is no standard treatment for elderly-unfit patients with muscle-invasive bladder cancer. Pelvic irradiation alone is an usual approach in this instance, and some reports have demonstrated that curative radiotherapy is feasible in elderly patients. To our knowledge, no data exist about the feasibility of a curative treatment in elderly patients with concomitant illness and a Charlson Comorbidity Index (an index of comorbidity that includes age) greater than 2. The main purpose of the present study was to establish the feasibility of irradiation in a cohort of elderly patients in poor general condition. Methods The records of 45 elderly-unfit patients (median age, 75 years; range, 70-85), with a comorbid Charlson score >2, treated with curative dose, planned continuous-course, external beam radiotherapy for muscle-invasive bladder cancer were reviewed. The patients were treated to a median total dose of 60 Gy (range, 56–64), with an average fractional dose of 190 ± 10 cGy using megavoltage (6–15 MV). All patients were treated with radiation fields encompassing the bladder and grossly involved lymph nodes with a radiographic margin of at least 1.5 cm. Results No treatment-related mortality and clinically insignificant acute morbidity was recorded. No patient was hospitalized during or after the irradiation because of gastrointestinal or urogenital side effects. In one patient a week rest from therapy was necessary due a febrile status. Median survival was 21.5 months; overall 3- and 5-year survival was 36% and 19.5%, respectively. Conclusions Elderly-unfit patients with comorbidities and >70 years of age can be submitted to radical pelvic irradiation. The results observed in this retrospective analysis have encouraged us to use non-palliative radiotherapy doses in these patients with muscle-invasive bladder cancer.

Phase II trial of durvalumab plus tremelimumab with concurrent radiotherapy as bladder-sparing therapy in patients with localized muscle invasive bladder cancer: A SOGUG study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. TPS5097-TPS5097
Author(s):  
M. Andres Cuellar ◽  
Ana Medina ◽  
Regina Girones ◽  
B.P. Valderrama ◽  
Albert Font ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Bladder Cancer ◽  
Phase Ii ◽  
External Beam Radiotherapy ◽  
Human Monoclonal Antibody ◽  
Pathological Response ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Muscle Invasive

TPS5097 Background: Several studies have shown that long-term bladder preservation is feasible in selected patients with muscle-invasive bladder cancer, using a multimodal treatment, including transurethral resection (TUR), radiotherapy and chemotherapy. Durvalumab, a fully human monoclonal antibody against PD-L1, has shown activity in patients with advanced pretreated urothelial cancer. A preclinical study showed that the combination of radiation, anti-CTLA4 and anti-PD-L1 overcome- adaptive immune resistance and has superior activity than either therapy alone (Twyman-Saint Victor et al. Nature 2015). The purpose of the present study is to explore feasibility, toxicity and activity in terms of response and bladder preservation of the integration of TUR, immune double checkpoint inhibition with durvalumab and tremelimumab (a fully human monoclonal antibody against CTLA-4), and radiotherapy in the treatment of localized muscle-invasive. Methods: This is a multicenter prospective phase II study of multimodal therapy in patients with localized urothelial carcinoma of the bladder in clinical stages T2-4a N0 M0, ECOG 0- 1, without contraindications to immunotherapy, who either wish for bladder preservation or are ineligible for cystectomy. The primary endpoint is pathological response (≤T1) at post-treatment biopsy. A 2-stage sequential design (response rate P0=5, P1=0.7, α=0.10, β=0.20) requires at least 6 responses in the first 12 pts to expand to a second cohort of 20 patients. The treatment consists of initial TUR of the tumor, followed by durvalumab 1500 mg i.v. plus tremelimumab 75 mg i.v., every 4 weeks for 3 doses. Normofractionated external-beam radiotherapy is started 2 weeks later, at doses of 46 Gy to the minor pelvis and 64-66 Gy to the bladder. Patients with pathological response will be candidates to bladder preservation, whereas those with residual muscle invasive tumor will be candidates to salvage cystectomy. At present time, prespecified activity goal for the first stage of accrual was met; second stage accrual began in December 2019. Clinical trial information: NCT03702179 .

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