Abbreviated concurrent chemoradiotherapy in node-negative muscle-invasive bladder cancer
Balata R, Hemeda R, Metwally MI, Malek MM, Elshorbagy S, Mandour D
Introduction Bladder cancer represents a major economic burden in Egypt, ranking as the second most common tumor in males 12.7%. Therefore, the goal of this research is to develop a hypofractionated treatment regimen that achieves a similar response at a lower cost and with less strain on the radiation machines.
Aim The aim of this study is to evaluate treatment outcome of hypofractionated concurrent chemo-radiotherapy using weekly cisplatin in muscle-invasive bladder cancer (MIBC).
Method From September 2019 till February 2021, 40 patients with node-negative muscle-invasive transitional cell carcinoma of the bladder, stage T2-T3N0M0, underwent maximal transurethral resection of bladder tumor followed by 3-dimensional conformal radiotherapy to the bladder in 45 Gy in 15 fractions with a weekly cisplatin dose of 30mg/m2. Treatment outcome was assessed by response and toxicity.
Results With a median follow-up time of 13 months (8-18 months), forty patients with a median age of 55.9 ± 8.4 years completed their treatment regimen. After 3 months of therapy, 26 patients (65%) had a complete local response, whereas 6 patients (15%) had progressive disease, 4 patients (10%) had local recurrence and 2 patients (5%) had with distant metastasis. Acute grade 3 gastrointestinal and genitourinary toxicities were 5% and 12.5% of all acute toxicities, respectively. 2.5% of patients had late grade 3 genitourinary toxicity. There were no reports of life-threatening complications or grade 4 toxicity.
Conclusion In node-negative bladder cancer, concurrent chemo-radiotherapy is a feasible and well-tolerated alternative to surgery. In addition to lower morbidity, this regimen offers effective treatment with low cost. However, T2 masses which were completely resected yielded better results.