Clinical outcomes of image guided adaptive hypofractionated weekly radiotherapy for bladder cancer in those unsuitable for radical treatment

Publication date: Available online 9 February 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): S. Hafeez, F. McDonald, S. Lalondrelle, H. McNair, K. Warren-Oseni, K. Jones, V. Harris, H. Taylor, V. Khoo, K. Thomas, V. Hansen, D. Dearnaley, A. Horwich, R. Huddart
Purpose/objectivesWe report on the clinical outcomes of a phase II study assessing image guided hypofractionated weekly radiotherapy in bladder cancer patients unsuitable for radical treatment.Methods and materialsFifty-five patients with T2-T4aNx-2M0-1 bladder cancer not suitable for cystectomy or daily radiotherapy treatment were recruited. A 'plan of the day' radiotherapy approach was used, treating whole (empty) bladder to 36Gy in 6 weekly fractions. Acute toxicity was assessed weekly during radiotherapy, at 6 and 12 weeks using Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Late toxicity was assessed at 6 months and 12 months using Radiation Therapy Oncology Group (RTOG) grading. Cystoscopy was used to assess local control at 3 months.Cumulative incidence function was used to determine local progression at 1 at 2 years. Death without local progression was treated as a competing risk. Overall survival were estimated using the Kaplan-Meier method.ResultsMedian age was 86 years (range 68-97 years). 87% patients completed their prescribed course of radiotherapy. Genito-urinary and gastro-intestinal grade 3 acute toxicity was seen in 18% (10/55) and 4% (2/55) patients respectively. No grade 4 genito-urinary or gastro-intestinal toxicity was seen. Grade >3 late toxicity (any) at 6 and 12 months was seen in 6.5% (2/31) and 4.3% (1/23) patients respectively.Local control following radiotherapy was 92% of assessed patients (60% total population). Cumulative incidence of local progression at 1 year and 2 years for all patients was 7% (95%CI 2%-17%) and 17% (95%CI 8%-29%) respectively. Overall survival at 1 year was 63% (95% CI 48%-74%).ConclusionHypofractionated radiotherapy delivered weekly with a plan of the day approach offers good local control with acceptable toxicity in a patient population not suitable for radical bladder treatment.

Teaser

This prospective study demonstrates that hypofractionated radiotherapy delivered with a plan of the day approach is well tolerated in those unfit for radical bladder cancer treatment. It provides opportunity for local disease and symptom control in patients for whom cystectomy, trimodality or daily radiotherapy is not appropriate.


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