Journal Article

Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study

Chapet, Olivier, Richaud, Pierre, Gaston, Richard, Fléchon, Aude, Sargos, Paul, Latorzeff, Igor, Roubaud, Guilhem, Brouste, Véronique, Orré, Mathieu, Piéchaud, Thierry

2017

Overview

Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC. We retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale. Between 2000 and 2013, 57 patients [median age 66.3 years (45-84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2-33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4-50). A boost of 16 Gy (5-22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30-60), 37% (95%CI 24-51) and 49% (95%CI 33-63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context. Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abdomen / Acute toxicity / Adenocarcinoma / Age / Aged / Aged, 80 and over / Aorta / Arteries / Benchmarks / Bifurcations / Biology and Life Sciences / Bladder / Bladder cancer / Bones / Cancer / Care and treatment / Chemotherapy / Cisplatin / Classification / Clinical outcomes / Clinical trials / Combined Modality Therapy / Computation / Computed tomography / Confidence intervals / Cystectomy - methods / Cytology / Death / Diagnosis / Dissection / Documents / Female / Guidelines / Health risks / Humans / Institutions / Intestine / Lymph nodes / Magnetic resonance imaging / Male / Medical personnel / Medical prognosis / Medicine and Health Sciences / Metastases / Metastasis / Middle Aged / Mortality / Muscles - pathology / Neoplasm Invasiveness / Radiation / Radiation therapy / Radiotherapy / Resonance / Retrospective Studies / Risk / Statistical methods / Statistics / Surgery / Survival / Survival Analysis / Terminology / Thorax / Toxicity / Tumors / Urinary bladder / Urinary Bladder Neoplasms - pathology / Urinary Bladder Neoplasms - radiotherapy / Urinary Bladder Neoplasms - surgery / Urine / Urology / Uterus / Vagina