CRT results: patients who do not accept radical cystectomy but they are not suitable for bladder-preserving treatment

Eda Erdiş; Mukaddes Yılmaz; Mahmut Uçar; Hatice Öz; Birsen Yücel

doi:10.7197/cmj.1706597

EN TR

CRT results: patients who do not accept radical cystectomy but they are not suitable for bladder-preserving treatment

Abstract

Introduction: This study aimed to evaluate overall survival (OS) and disease-free survival (DFS) in patients with muscle-invasive bladder cancer (MIBC) who refused radical cystectomy and were not eligible for bladder-preserving treatment, and to identify prognostic factors affecting these outcomes under chemoradiotherapy (CRT). Materials and Methods: A total of 71 patients with non-metastatic MIBC who underwent definitive CRT between 2010 and 2024 were retrospectively analyzed. Clinical findings and survival outcomes following CRT were evaluated. Results: Among the 71 patients with bladder cancer, 90% were male and 10% were female. The median age was 72 years. Local recurrence occurred in 23 patients (32%), and distant metastasis was observed in 52 patients (73%). Male gender, concurrent chemotherapy including a platinum-based regimen, and a radiotherapy dose ≥60 Gy were identified as independent favorable prognostic factors for both OS and DFS. In addition, performance status was found to be an independent prognostic factor affecting OS. Conclusion: Definitive chemoradiotherapy appears to be a reasonable treatment option for appropriately selected patients with muscle-invasive bladder cancer, particularly in those who decline radical cystectomy or are ineligible for trimodal bladder-preserving therapy.

Keywords

Radikal Sistektomiyi kabul etmeyen mesane koruyucu tedaviye de uygun olmayan hastaların KRT sonuçları

Öz

Giriş: Bu çalışmada kas invaziv mesane kanserinde radikal sistektomiyi kabul etmeyen hastalarda koruyucu tedavi de uygun olmayan hastalarin kemoradyoterapi (KRT) ile genel sağkalımı (OS) ve disease free survival (DFS) etkileyen prognostik faktörlerin araştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya, 2010-2024 yılları arasında metastatik olmayan kas invaziv mesane kanseri olan 71 hasta dahil edildi. Klinik bulgular ve KRT sonrası sağkalım analizi değerlendirildi. Bulgular: Mesane kanserli 71 hastanın verileri incelendiğinde hastaların %90’ının erkek, %10’unun kadın olduğu saptanmıştır. Hastaların medyan yaşı 72 idi. 23 (%32) hastada lokal nüks ve 52 (%73) hastada uzak metastaz gelişmiştir. Erkek cinsiyet, eşzamanlı kemoterapi rejiminde platin kullanımı, RT dozunun ≥60 Gy olması hem OS’yi hemde DFS’yi etkileyen bağımsız iyi prognostik faktör olarak bulunmuştur. Ayrıca performans durumu da OS’yi etkileyen bağımsız iyi prognostik faktör olarak tespit edilmiştir. Sonuç: Kas invaziv mesane kanseri özellikle radikal sistektomiyi reddeden ya da mesane koruyucu trimodal tedaviye uygun olmayan hastalarda uygulanan definitif kemoradyoterapi uygun hastalarda makul bir seçenektir.

Anahtar Kelimeler

Kaynakça

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12–49. doi:10.3322/caac.21820
2. Lobo N, Afferi L, Moschini M, et al. Epidemiology, screening, and prevention of bladder cancer. Eur Urol Oncol. 2022;5(6):628–639. doi:10.1016/j.euo.2022.10.003
3. Konieczkowski DJ, Efstathiou JA, Mouw KW. Contemporary and emerging approaches to bladder-preserving therapy. Hematol Oncol Clin North Am. 2021;35:567–84. doi.org/10.1016 /j.hoc.2021.03.001
4. Mohanty SK, Lobo A, Mishra SK, Cheng L. Precision medicine in bladder cancer. J Pers Med. 2023;13:756. doi.org/10.3390/ jpm13050756
5. Gakis G, Efstathiou J, Lerner SP, et al. ICUD EAU International Consultation on Bladder Cancer 2012. Eur Urol. 2013;63(1):45–57. doi.org/10.1016/j.eururo.2012.08.009
6. Cahn DB, Ristau BT, Ghiraldi EM, et al. Bladder preservation therapy: A review. Urology. 2016;96:54–61. doi.org/10. 1016/j.urology. 2016.05.041
7. Biagioli MC, Fernandez DC, Spiess PE, Wilder RB. Bladder preservation for urothelial cancer. Cancer Control. 2013;20(3):188–99. doi.org/10.1177/107327481302000307
8. James ND, Hall E, Hussain SA, et al. Radiotherapy with or without chemotherapy for bladder cancer. N Engl J Med. 2012;366(16):1477–88. doi: 10.1056/NEJMoa1106106

9. Coppin CM, Gospodarowicz MK, James K, et al. Concurrent cisplatin and radiation in bladder cancer. J Clin Oncol. 1996;14(1):2901–07. doi.org/10.1200/JCO.1996.14.11.2901
10. Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. Springer; 2017.
11. Ulbright TM, Amin MB, Balzer B, et al. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Geneva, Switzerland: WHO Press; 2016:189–226.
12. Duncan W, Quilty PM. The results of a series of 963 patients with transitional cell carcinoma of the urinary bladder primarily treated by radical megavoltage X ray therapy. Radiother Oncol. 1986;7(4):299–310. doi.org/10.1016/ S0167-8140(86)80059-7
13. Pollack A, Zagars GK, Swanson DA. Muscle invasive bladder cancer treated with external beam radiotherapy: prognostic factors. Int J Radiat Oncol Biol Phys. 1994;30(2):267–277. doi.org/10.1016 /0360-3016(94)90004-3
14. Hagan MP, Witner KA, Kaufman DS, et al. RTOG 97 06: initial report of a phase I–II trial of selective bladder conservation using TURBT, twice daily accelerated irradiation sensitized with cisplatin, and adjuvant MCV combination chemotherapy. Int J Radiat Oncol Biol Phys. 2003;57(3):665–72. doi.org/10.1016 /S0360-3016(03)00718-1
15. Tester W, Porter A, Asbell S, et al. Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12. Int J Radiat Oncol Biol Phys. 1993;25(5):783–90. doi.org/10.1016 /0360-3016(93)90306
16. Kaufman DS, Winter KA, Shipley WU, et al. The initial results in muscle invading bladder cancer of RTOG 95 06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5 fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist. 2000;5(6):471–6. doi.org/10.1634/ theoncologist.5-6-471
17. Kaufman DS, Winter KA, Shipley WU, et al. Phase I/II RTOG study (99-06) of patients with muscle invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology. 2009;73(4):833–7. doi.org/10.1016 /j.urology.2008.09.036
18. Wujanto C, Tey J, Chia D, Ho F, Ooi KH, Wong AS, et al. Radical radiotherapy in older patients with muscle invasive bladder cancer. J Geriatr Oncol. 2019;10(2):292–7. doi.org/10.1016 /j.jgo.2018.10.015
19. Huddart RA, Hall E, Hussain SA, et al. Randomized noninferiority trial of reduced high dose volume versus standard volume radiation therapy for muscle invasive bladder cancer: results of the BC2001 trial (CRUK/01/004). Int J Radiat Oncol Biol Phys. 2013;87(2):261–269. doi.org/10.1016/j.ijrobp.2013.06.2044
20. Lee YT, Wu YT, Yen CC, Chang MH, et al. Concurrent chemoradiotherapy in elderly patients with muscle invasive bladder cancer: a single center experience. J Cancer Res Pract. 2016;3(3):73–6. doi.org/10.1016/j.jcrpr.2016.05.003
21. Hsieh CH, Chung SD, Chan PH, et al. Intensity modulated radiotherapy for elderly bladder cancer patients. Radiat Oncol. 2011;6(1):75.
22. Korpics MC, Block AM, Martin B, Hentz C, et al. Concurrent chemotherapy is associated with improved survival in elderly patients with bladder cancer undergoing radiotherapy. Cancer. 2017;123(18):3524–31. doi.org/10.1002/cncr.30719

Ayrıntılar

Birincil Dil

İngilizce

Konular

Multimorbidite , Uygulama Bilimi ve Değerlendirme

Bölüm

Araştırma Makalesi

Yazarlar

Eda Erdiş ^*
0000-0003-3003-8643
Türkiye

Mukaddes Yılmaz
0000-0002-7927-8480
Türkiye

Mahmut Uçar
0000-0002-3311-6152
Türkiye

Hatice Öz
0009-0008-4919-8536
Türkiye

Birsen Yücel
0000-0002-0083-6866
Türkiye

Yayımlanma Tarihi

21 Haziran 2025

Gönderilme Tarihi

27 Mayıs 2025

Kabul Tarihi

11 Haziran 2025

Yayımlandığı Sayı

Yıl 2025 Cilt: 47 Sayı: 2

DOI

https://doi.org/10.7197/cmj.1706597

IZ

https://izlik.org/JA42SY96CE

Kaynak Göster

RIS / Bibtex

AMA

1.Erdiş E, Yılmaz M, Uçar M, Öz H, Yücel B. CRT results: patients who do not accept radical cystectomy but they are not suitable for bladder-preserving treatment. CMJ. 2025;47(2):28-34. doi:10.7197/cmj.1706597