Moore Assaf, Lobaugh Stephanie M, Zhang Zhigang, Rosenberg Jonathan E, Iyer Gopa, Teo Min Yuen, Bochner Bernard, Donahue Timothy, Nunez David Aramburu, Dreyfuss Alexandra, Gorovets Daniel, Zelefsky Michael J, Kollmeier Marisa A
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Tel Aviv University, Tel Aviv, Israel.
Bladder Cancer. 2023 Jun 27;9(2):141-150. doi: 10.3233/BLC-220121. eCollection 2023.
Various radiotherapeutic regimens are used in the treatment of bladder cancer.
We aimed to evaluate early toxicity and outcomes associated with hypofractionated radiation therapy (Hypo-RT), 55Gy in 20 fractions.
We identified 40 patients who received definitive Hypo-RT for localized bladder cancer. Most patients were men (62.5%), elderly (median age 82), had high Charlson Comorbidity Index score (median 7, range 4-9) and were nonsurgical candidates (80%). Sixty-eight percent had a macroscopically complete transurethral resection of bladder tumor (TURBT) and 33 patients (82.5%) received concurrent chemotherapy. Acute (< =3mo) and late (>3mo) toxicities were assessed according to CTCAE v4.0. Survival outcomes were estimated using the Kaplan-Meier method. Median follow up after Hypo-RT was 32 months (95% CI: 28-49 months).
Overall rates of acute grade 2 genitourinary (GU) and gastrointestinal (GI) toxicities were 40% each, most commonly urinary frequency and diarrhea. Two cases of acute grade 3 GU/GI toxicity occurred. Late grade 2+ toxicity occurred in 3 patients (7.5%): 2 grade 2 GU and 1 grade 3 GI. Seventy-seven percent achieved a complete response (CR). Six patients (20%) developed disease recurrence at a median time of 9.1 months. The estimated 2-year DFS and 2-year DSS rate were 59% (95% CI, 45-78%) and 78% (95% CI, 65-93%), respectively. Receipt of concurrent chemotherapy ( = 0.003) and achieving a CR ( = 0.018) were univariably associated with improved DSS. Tis component was associated with worse DSS ( = 0.015).
Hypo-RT had a favorable toxicity profile and encouraging cancer control outcomes in this mostly elderly and frail patient cohort.
多种放射治疗方案用于膀胱癌的治疗。
我们旨在评估大分割放射治疗（Hypo-RT），即20次分割给予55Gy的早期毒性和治疗结果。
我们纳入了40例接受局限性膀胱癌根治性Hypo-RT治疗的患者。大多数患者为男性（62.5%），年龄较大（中位年龄82岁），Charlson合并症指数评分较高（中位值7，范围4 - 9），且不适合手术（80%）。68%的患者膀胱肿瘤经尿道切除术（TURBT）肉眼下完全切除，33例患者（82.5%）接受了同步化疗。根据CTCAE v4.0评估急性（<=3个月）和晚期（>3个月）毒性。使用Kaplan-Meier方法估计生存结果。Hypo-RT后的中位随访时间为32个月（95%CI：28 - 49个月）。
急性2级泌尿生殖系统（GU）和胃肠道（GI）毒性的总体发生率均为40%，最常见的是尿频和腹泻。发生了2例急性3级GU/GI毒性。3例患者（7.5%）出现晚期2级及以上毒性：2例2级GU和1例3级GI。77%的患者达到完全缓解（CR）。6例患者（20%）在中位时间9.1个月时出现疾病复发。估计的2年无病生存率（DFS）和2年疾病特异性生存率（DSS）分别为59%（95%CI，45 - 78%）和78%（95%CI，65 - 93%）。接受同步化疗（P = 0.003）和达到CR（P = 0.018）与改善DSS单因素相关。Tis成分与较差的DSS相关（P = 0.015）。
在这个主要为老年体弱患者队列中，Hypo-RT具有良好的毒性特征和令人鼓舞的癌症控制效果。
