Introduction & Objectives
For muscle-invasive bladder cancer, radical cystectomy has been a standard curative option with about 50% of 5-year local control rate and 20 – 40% or Overall Survival (OS) rates. However, for some patients inappropriate for radical surgery due to co-morbidities, old ages, or patient refusal, definitive radiotherapy is a proper therapeutic option. Recently, use of TURBT and RT with or without concurrent chemotherapy has been adopted for bladder conservation. Patients after bladder-preserving therapy are expected to have comparable survival outcomes correspond to previous radical cystectomy results, as well as better quality of life with intact bladder function. Therefore, we collected and analyzed clinical data from 7 institutions affiliated with Korean Radiation Oncology Group (KROG) to retrospectively review the current treatment status and to evaluate survival rates and prognostic factors related to treatment outcomes after bladder-preserving therapy including TURBT, RT, and chemotherapy.
Material & Methods
We conducted a multi-institutional retrospective study of 152 patients with stage Ⅱ to Ⅳ bladder cancer treated with curative radiotherapy from 2000 to 2010. The range of age was 37 to 94 years old (median 72). There were 72 patients in stage Ⅱ, 49 in Ⅲ, and 31 in Ⅳ. Ninety-seven patients were treated with Concurrent Chemoradiotherapy (CCRT) and 55 patients with RT alone. Radiation was delivered to the pelvis (31.2 – 70.2 Gy, median 63 Gy). Chemotherapeutic agents mainly administered with radiation were gemcitabine and cisplatin. The follow up periods ranged from 2 to 166 months (median 35.5 months).
Sixty-nine patients (45.4%) showed complete response to radiotherapy and 46 (30.3%) did partial response. Five-year overall survival rate (OS) was 45.8% and 5-year disease specific survival rate (DSS) was 48.9%. On univariate analysis for prognostic factors, there were statistical significances on patient age, initial hemoglobin level, cT stage, cN stage, cTNM stage, and hydronephrosis in OS and DSS. On multivariate analysis, patient age (95% CI, 0.325 to 0.788; HR, 0.506; p=0.003 in OS, 95% CI, 0.264 to 0.689; HR, 0.426; pto be statistically significant for OS and DSS.
We thought our survival rates were comparable to those of other studies. Bladder cancer detection before getting older may influence the better survival outcomes. It is suggested that further randomized studies are needed to be elucidate the impact of radiotherapy in bladder cancer.