To evaluate the significance of local radiation therapy (LRT) for prevention of local symptoms (LSs) caused by muscle-invasive bladder cancer (MIBC).
We retrospectively reviewed the clinical records of 133 patients from 13 hospitals. MIBC patients with or without metastases who were treated with LRT alone from January 2015 through December 2020 were enrolled. Exclusion criteria were urinary diversion (UD) prior to LRT, non-MIBC, or lack of clinical information. LSs were defined as hematuria requiring invasive treatment or transfusion, UD after LRT, bladder tamponade, and opioid use for bladder pain.
One hundred fourteen patients were finally enrolled in the study. During the median follow-up period of 13.5 months, 30 patients (26.3%) had LSs. Risk factors of LSs in multivariate analysis were a prior history of non-MIBC (NMIBC) (hazard ratio [HR] 2.99; 95% confidence interval [CI], 1.36 to 6.56; P < 0.01), radiation dose of less than 50 Gray (Gy) (HR 3.99; 95% CI, 1.80 to 8.82; P < 0.01), and tumor stage 3 or more (HR 2.43; 95% CI, 1.14 to 5.21; P = 0.02). Risk factors of overall survival (OS) in multivariate analysis were being female (HR 3.32; 95% CI, 1.68 to 6.58; P < 0.01), an age-adjusted Charlson Comorbidity index of 6 or more (HR 2.19; 95% CI, 1.18 to 4.10; P = 0.01), distant metastases (HR 3.20; 95% CI, 1.39 to 6.58; P < 0.01), and tumor size of 40 mm or more (HR 2.38; 95% CI, 1.34 to 4.52; P < 0.01). Toxicity (all grades) occurred in 40.4% of the patients, 4.8% with grade 3 or more and 95.2% with lower grades.
We determined the risk factors for LSs in MIBC patients treated with LRT alone. An escalated-dose of 50 Gy or more may contribute to prevention of LSs caused by MIBC. Thus, dose-escalated LRT for MIBC patients who can expect favorable survival may be a good option to avoid future annoying LSs.
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2023 Oct 03*** epublish ***
Manabu Okada, Tetsuya Shindo, Keiko Fujino, Toshihiro Maeda, Naoki Ito, Atsushi Takahashi, Hiroshi Hotta, Yasuharu Kunishima, Masanori Matsukawa, Akio Takayanagi, Atsushi Wanifuchi, Seisuke Nofuji, Ryuichi Kato, Fumimasa Fukuta, Kohei Hashimoto, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori
Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan., Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan. ., Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan., Department of Urology, Oji General Hospital, Tomakomai, Japan., Department of Urology, NTT East Medical Center Sapporo, Sapporo, Japan., Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan., Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan., Department of Urology, Sunagawa City Medical Center, Sunagawa, Japan., Department of Urology, Takikawa Municipal Hospital, Takikawa, Japan., Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan., Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan., Department of Urology, Hokkaido Medical Center, Sapporo, Japan., Department of Urology, Muroran City General Hospital, Muroran, Japan., Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan.