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
Kemoradyoterapi mesane kanseri radikal sistektomi mesane koruyucu tedavi prognostik faktörler genel sağkalım hastalıksız sağkalım
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
CRT results: patients who do not accept radical cystectomy but they are not suitable for bladder-preserving treatment
Öz
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.
Anahtar Kelimeler
Chemoradiotherapy bladder cancer radical cystectomy bladder-preserving treatment prognostic factors overall survival
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 | |
| Yayımlanma Tarihi | 21 Haziran 2025 |
| Gönderilme Tarihi | 27 Mayıs 2025 |
| Kabul Tarihi | 11 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 47 Sayı: 2 |
