Bladder preservation with conformal radiotherapy using a simultaneous boost with concurrent cisplatin in patients with muscle-invasive bladder cancer

Background: The estimated annual incidence of bladder cancer in Egypt is
10,655 cases, accounting for 7.9% of all newly diagnosed cancers. Sharkia
population exceeds 8 million with only a few radiotherapy machines available,
in addition, the global coronavirus (COVID-19) pandemic, therefore, shorter
overall treatment duration would be more convenient for the patient quality of
life.
Purpose: The aim of this study is to evaluate treatment outcome of bladder
preservation with conformal radiotherapy using a simultaneous boost with
concurrent cisplatin in patients with muscle-invasive bladder cancer (MIBC).
Materials and methods: From May 2021 to April 2022, 34 patients with
muscle-invasive transitional cell bladder cancer, T2–3 N0 M0 were treated with
maximum transurethral resection of bladder tumor (TURBT), followed by
conformal hypofractionated radiotherapy in a dose of 2.4 Gy to the pelvis in the
morning and a simultaneous radiotherapy boost in the evening in a dose of
1.33 Gy to the whole bladder for all 15 days of treatment (36 Gy to the pelvis
and 20 Gy to whole bladder) with a weekly Cisplatin dose of 30 mg/m2
.
Treatment outcome was assessed by response and toxicity.
Results: All 34 patients with a median age of 57 ± 6.64 years completed their
treatment regimen. After 3 months of therapy, 26 patients (76.5%) had an
overall response, whereas 8 patients (23.5%) showed no response. Grade 3
anemia was prominent in 3 patients (8.8%), whereas, acute grade 3 cystitis
persisted in 5 patients (14.7%). There were no reports of life-threatening
complications or grade 4 toxicity.
Conclusions: Conformal radiotherapy using a simultaneous boost with
concurrent cisplatin in patients with muscle-invasive bladder cancer is a
shortened and acceptable alternative to the prolonged 6-6.5 weeks radiotherapy
protocol in T2–3 N0 M0 bladder cancer. Absence of hydronephrosis and
complete TUR are of better outcome.
Recommendation: Other radiosensitizers can be experimented and enrollment
of larger number of patients can be of better significance. In addition, new
protocols using node-positive disease could be further studied over extended
periods with documentation of local control and survival.