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Radiotherapy for the Treatment of Muscle-Invasive Bladder Cancer

  • Barbara Alicja Jereczek-Fossa
  • Giulia Marvaso
Chapter

Abstract

Bladder preservation based on trimodal therapy (TMT) is an option for muscle-invasive bladder cancer (MIBC) patients unwilling to undergo radical cystectomy (RC) or unfit for radical surgery. Although randomized studies are missing, numerous reprospective and prospective series showed that TMT offers satisfactory oncological outcomes, comparable to RC with or without chemotherapy, with salvage cystectomy being reserved for patients with incomplete response or local muscle-invasive relapse. Regarding the irradiation, the standard fractionation usually is of 1.8–2 Gy/fraction with the total irradiation dose to the whole bladder being approximately 55–66 Gy and 45–50 Gy to the pelvic lymph nodes. The recent advances in the radiotherapic field, such as the introduction of intensity modulated radiotherapy (IMRT) and the image guided radiotherapy (IGRT), have improved conformity of the radiation dose to the target volume and reduced the gastrointestinal and genitourinary toxicity. Based on the current literature TMT option should be discussed in highly selected patients motivated to preserve their urinary bladder.

Keywords

Radiotherapy Trimodal treatment Bladder sparing Salvage cystectomy Intensity modulated radiotherapy 

References

  1. 1.
    Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. 2017;71(1):96–108.  https://doi.org/10.1016/j.eururo.2016.06.010.CrossRefPubMedGoogle Scholar
  2. 2.
    Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, Skinner E, Bochner B, Thangathurai D, Mikhail M, Raghavan D, Skinner DG. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19(3):666–75.CrossRefPubMedGoogle Scholar
  3. 3.
    Bellmunt J, Orsola A, Leow JJ, Wiegel T, De Santis M, Horwich A, ESMO Guidelines Working Group. Bladder cancer: ESMO practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii40–8.  https://doi.org/10.1093/annonc/mdu223.CrossRefPubMedGoogle Scholar
  4. 4.
    Yang LS, Shan BL, Shan LL, Chin P, Murray S, Ahmadi N, Saxena A. A systematic review and meta-analysis of quality of life outcomes after radical cystectomy for bladder cancer. Surg Oncol. 2016;25(3):281–97.  https://doi.org/10.1016/j.suronc.2016.05.027.CrossRefPubMedGoogle Scholar
  5. 5.
    Koiso K, Shipley W, Keuppens F, Baert L, Hall R, Hudson MA, Khoury S, Kubota Y, Kubota Y, van Poppel H. The status of bladder-preserving therapeutic strategies in the management of patients with muscle-invasive bladder cancer. Int J Urol. 1995;2(Suppl 2):49–57. Review. Erratum in: Int J Urol 1995 Jul;2(3):214.CrossRefPubMedGoogle Scholar
  6. 6.
    James ND, Hussain SA, Hall E, Jenkins P, Tremlett J, Rawlings C, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366:1477–88.CrossRefPubMedGoogle Scholar
  7. 7.
    Arcangeli G, Arcangeli S, Strigari L. A systematic review and meta-analysis of clinical trials of bladder-sparing trimodality treatment for muscle-invasive bladder cancer (MIBC). Crit Rev Oncol Hematol. 2015;94(1):105–15.  https://doi.org/10.1016/j.critrevonc.2014.11.007.CrossRefPubMedGoogle Scholar
  8. 8.
    Efstathiou JA, Spiegel DY, Shipley WU, Heney NM, Kaufman DS, Niemierko A, Coen JJ, Skowronski RY, Paly JJ, McGovern FJ, Zietman AL. Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol. 2012;61(4):705–11.  https://doi.org/10.1016/j.eururo.2011.11.010.CrossRefPubMedGoogle Scholar
  9. 9.
    Dunst J, Sauer R, Schrott KM, Kühn R, Wittekind C, Altendorf-Hofmann A. Organ-sparing treatment of advanced bladder cancer: a 10-year experience. Int J Radiat Oncol Biol Phys. 1994;30(2):261–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Progetto ROL (Rete Oncologica Lombarda). Linee guida. http:// www.progettorol.it/rol/access_to.asp?escpw=guidelines. Accessed 10 Dec 2017.
  11. 11.
    Biagioli MC, Fernandez DC, Spiess PE, Wilder RB. Primary bladder preservation treatment for urothelial bladder cancer. Cancer Control. 2013;20(3):188–99.CrossRefPubMedGoogle Scholar
  12. 12.
    Smith ZL, Christodouleas JP, Keefe SM, Malkowicz SB, Guzzo TJ. Bladder preservation in the treatment of muscle-invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy. BJU Int. 2013;112(1):13–25.  https://doi.org/10.1111/j.1464-410X.2012.11762.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Krasnow RE, Drumm M, Roberts HJ, Niemierko A, Wu CL, Wu S, Zhang J, Heney NM, Wszolek MF, Blute ML, Feldman AS, Lee RJ, Zietman AL, Shipley WU, Efstathiou JA. Clinical outcomes of patients with histologic variants of urothelial cancer treated with trimodality bladder-sparing therapy. Eur Urol. 2017;72(1):54–60.  https://doi.org/10.1016/j.eururo.2016.12.002.CrossRefPubMedGoogle Scholar
  14. 14.
    Sweeney P, Kursh ED, Resnick MI. Partial cystectomy. Urol Clin North Am. 1992;19(4):701–11.PubMedGoogle Scholar
  15. 15.
    Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, Lotan Y, Meeks JJ, Michalski JM, Morgan TM, Quale DZ, Rosenberg JE, Zietman AL, Holzbeierlein JM. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol. 2017;198(3):552–9.  https://doi.org/10.1016/j.juro.2017.04.086.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Smaaland R, Akslen LA, Tønder B, Mehus A, Lote K, Albrektsen G. Radical radiation treatment of invasive and locally advanced bladder carcinoma in elderly patients. Br J Urol. 1991;67(1):61–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Pos FJ, Hart G, Schneider C, Sminia P. Radical radiotherapy for invasive bladder cancer: What dose and fractionation schedule to choose? Int J Radiat Oncol Biol Phys. 2006;64(4):1168–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Leissner J, Ghoneim MA, Abol-Enein H, Thuroff JW, Franzaring L, Fisch M, et al. Extended radical lymphadenectomy in patients with urothelial bladder cancer: results of a prospective multicenter study. J Urol. 2004;171(1):139–44.CrossRefPubMedGoogle Scholar
  19. 19.
    Poulsen AL, Horn T, Steven K. Radical cystectomy: extending the limits of pelvic lymph node dissection improves survival for patients with bladder cancer confined to the bladder wall. J Urol. 1998;160(6 Pt 1):2015–9. discussion 2020.PubMedGoogle Scholar
  20. 20.
    Goldsmith B, Baumann BC, He J, Tucker K, Bekelman J, Deville C, et al. Occult pelvic lymph node involvement in bladder cancer: implications for definitive radiation. Int J Radiat Oncol Biol Phys. 2014;88:603–10.CrossRefPubMedGoogle Scholar
  21. 21.
    Tunio MA, Hashmi A, Qayyum A, et al. Whole pelvis or bladder-only chemoradiation for lymph node-negative invasive bladder cancer: single institution experience. Int J Radiat Oncol Biol Phys. 2012;82:e457–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Cowan RA, McBain CA, Ryder WD, Wylie JP, Logue JP, Turner SL, et al. Radiotherapy for muscle-invasive carcinoma of the bladder: results of a randomized trial comparing conventional whole bladder with dose-escalated partial bladder radiotherapy. Int J Radiat Oncol Biol Phys. 2004;59:197–207.CrossRefPubMedGoogle Scholar
  23. 23.
    Mangar SA, Foo K, Norman A, Khoo V, Shahidi M, Dearnaley DP, et al. Evaluating the effect of reducing the high-dose volume on the toxicity of radiotherapy in the treatment of bladder cancer. Clin Oncol (R Coll Radiol). 2006;18:466–73.CrossRefGoogle Scholar
  24. 24.
    Lutkenhaus LJ, van Os RM, Bel A, Hulshof MC. Clinical results of conformal versus intensity-modulated radiotherapy using a focal simultaneous boost for muscle-invasive bladder cancer in elderly or medically unfit patients. Radiat Oncol. 2016;11:45.  https://doi.org/10.1186/s13014-016-0618-6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Van Rooijen DC, Van De Kamer JB, Hulshof M, et al. Improving bladder cancer treatment with radiotherapy using separate intensity modulated radiotherapy plans for boost and elective fields. J Med Imaging Radiat Oncol. 2010;54:256–63.CrossRefPubMedGoogle Scholar
  26. 26.
    Hsieh C-H, Chung S-D, Chan P-H, et al. Intensity modulated radiotherapy for elderly bladder cancer patients. Radiat Oncol. 2011;6:75.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Søndergaard J, Olsen KØ, Muren LP, Elstrøm UV, Grau C, Høyer M. A study of image-guided radiotherapy of bladder cancer based on lipiodol injection in the bladder wall. Acta Oncol. 2010;49(7):1109–15.  https://doi.org/10.3109/02841861003789491.CrossRefPubMedGoogle Scholar
  28. 28.
    Pieters BR, van der Steen-Banasik E, Smits GA, et al. GEC-ESTRO/ACROP recommendations for performing bladder-sparing treatment with brachytherapy for muscle-invasive bladder carcinoma. Radiother Oncol. 2017;122(3):340–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Arcangeli G, Strigari L, Arcangeli S. Radical cystectomy versus organ-sparing trimodality treatment in muscle-invasive bladder cancer: a systematic review of clinical trials. Crit Rev Oncol Hematol. 2015;95(3):387–96.  https://doi.org/10.1016/j.critrevonc.2015.04.006.CrossRefPubMedGoogle Scholar
  30. 30.
    Gray PJ, Fedewa SA, Shipley WU, Efstathiou JA, Lin CC, Zietman AL, Virgo KS. Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. Eur Urol. 2013;63(5):823–9.  https://doi.org/10.1016/j.eururo.2012.11.015.CrossRefPubMedGoogle Scholar
  31. 31.
    Svatek RS, Shariat SF, Novara G, Skinner EC, Fradet Y, Bastian PJ, Kamat AM, Kassouf W, Karakiewicz PI, Fritsche HM, Izawa JI, Tilki D, Ficarra V, Volkmer BG, Isbarn H, Dinney CP. Discrepancy between clinical and pathological stage: external validation of the impact on prognosis in an international radical cystectomy cohort. BJU Int. 2011;107(6):898–904.  https://doi.org/10.1111/j.1464-410X.2010.09628.x.CrossRefPubMedGoogle Scholar
  32. 32.
    Zietman AL, Sacco D, Skowronski U, Gomery P, Kaufman DS, Clark JA, Talcott JA, Shipley WU. Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors. J Urol. 2003;170(5):1772–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Cahn DB, Handorf EA, Ghiraldi EM, Ristau BT, Geynisman DM, Churilla TM, Horwitz EM, Sobczak ML, Chen DYT, Viterbo R, Greenberg RE, Kutikov A, Uzzo RG, Smaldone MC. Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer. Cancer. 2017;123(22):4337–45.  https://doi.org/10.1002/cncr.30900.CrossRefPubMedGoogle Scholar
  34. 34.
    Mak RH, Hunt D, Shipley WU, Efstathiou JA, Tester WJ, Hagan MP, Kaufman DS, Heney NM, Zietman AL. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of radiation therapy oncology group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol. 2014;32(34):3801–9.  https://doi.org/10.1200/JCO.2014.57.5548. Epub 2014 Nov 3. Erratum in: J Clin Oncol. 2015 Mar 1;33(7):814.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Giacalone NJ, Shipley WU, Clayman RH, et al. Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer: an updated analysis of the Massachusetts General Hospital experience. Eur Urol. 2017;71:952–60.CrossRefPubMedGoogle Scholar
  36. 36.
    Gofrit ON, Nof R, Meirovitz A, Pode D, Frank S, Katz R, Shapiro A, Landau EH, Hidas G, Yutkin V, Duvdevani M, Wygoda M. Radical cystectomy vs. chemoradiation in T2-4aN0M0 bladder cancer: a case-control study. Urol Oncol. 2015;33(1):19.e1–5.  https://doi.org/10.1016/j.urolonc.2014.09.014.CrossRefGoogle Scholar
  37. 37.
    Kulkarni GS, Hermanns T, Wei Y, Bhindi B, Satkunasivam R, Athanasopoulos P, Bostrom PJ, Kuk C, Li K, Templeton AJ, Sridhar SS, van der Kwast TH, Chung P, Bristow RG, Milosevic M, Warde P, Fleshner NE, Jewett MAS, Bashir S, Zlotta AR. Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic. J Clin Oncol. 2017;35(20):2299–305.  https://doi.org/10.1200/JCO.2016.69.2327.CrossRefPubMedGoogle Scholar
  38. 38.
    Kim YJ, Byun SJ, Ahn H, Kim CS, Hong BS, Yoo S, Lee JL, Kim YS. Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: a propensity score matching analysis. Oncotarget. 2017;8(40):68996–9004.  https://doi.org/10.18632/oncotarget.16576.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Seisen T, Sun M, Lipsitz SR, Abdollah F, Leow JJ, Menon M, Preston MA, Harshman LC, Kibel AS, Nguyen PL, Bellmunt J, Choueiri TK, Trinh QD. Comparative effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder. Eur Urol. 2017;72(4):483–7.  https://doi.org/10.1016/j.eururo.2017.03.038.CrossRefPubMedGoogle Scholar
  40. 40.
    Noon AP, Albertsen PC, Thomas F, Rosario DJ, Catto JW. Competing mortality in patients diagnosed with bladder cancer: evidence of undertreatment in the elderly and female patients. Br J Cancer. 2013;108(7):1534–40.  https://doi.org/10.1038/bjc.2013.106.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Weizer AZ, Palella GV, Montgomery JS. Managing muscle-invasive bladder cancer in the elderly. Expert Rev Anticancer Ther. 2010;10(6):903–15.  https://doi.org/10.1586/era.10.71.CrossRefPubMedGoogle Scholar
  42. 42.
    Turgeon GA, Souhami L. Trimodality therapy for bladder preservation in the elderly population with invasive bladder cancer. Front Oncol. 2014;4:206.  https://doi.org/10.3389/fonc.2014.00206.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Huddart RA, Birtle A, Maynard L, Beresford M, Blazeby J, Donovan J, Kelly JD, Kirkbank T, McLaren DB, Mead G, Moynihan C, Persad R, Scrase C, Lewis R, Hall E. Clinical and patient-reported outcomes of SPARE—a randomised feasibility study of selective bladder preservation versus radical cystectomy. BJU Int. 2017;120(5):639–50.  https://doi.org/10.1111/bju.13900.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Barbara Alicja Jereczek-Fossa
    • 1
    • 2
  • Giulia Marvaso
    • 2
  1. 1.Department of Oncology and Hemato-OncologyUniversity of MilanMilanItaly
  2. 2.Division of RadiotherapyEuropean Institute of OncologyMilanItaly

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