Page 88 - ARNM-3-2

Advances in Radiotherapy
& Nuclear Medicine Radiotherapy in node-positive bladder cancer

A B

C

Figure 4. Effects of different variables on survival. (A) Effect of induction SACT: Patients who received induction SACT had a significantly improved OS
compared to those who did not (median OS: 40.1 months vs. 13.6 months; HR: 0.16; 95% CI: 0.02 – 1.12; p=0.002); (B) Effect of histology: Patients with
pure TCCs had a non-significant trend toward improved OS (median OS not reached), compared to those with divergent squamous or neuroendocrine
differentiation (median OS: 17.93 months; HR: 0.60; 95% CI: 13 – 2.68; p=0.49); (C) Effect of co-morbidity: Patients with ASA1 or ASA2 had a non-
significant trend toward improved OS (median OS: 40.1 months), compared to those with ASA3 or ASA4 (median OS: 23.1 months; HR: 0.50; 95% CI:
0.09 – 2.64; p=0.32).
Abbreviations: ASA: American Society of Anesthesiologists; HR: Hazard ratio; OS: Overall survival; SACT: Systemic anti-cancer therapy; TCC: Transitional
cell carcinoma.

imaging with imaging-guided RT detects variations in During treatment, the CRT group experienced slightly more
the size, shape, and location of organs between fractions. grade 3 or 4 adverse events than the RT group (36.0% vs.
Smaller radiation volumes can be used with image-guided 27.5%, p=0.07), but not during FU (8.3% vs. 15.7%, p=0.07).
RT without running the risk of geographical miss as it can 16
In a study by Hoskin et al., 333 patients with MIBC
detect differences in organ movements and bladder filling were randomly assigned to either RT alone or RT with
across fractions. 13
concurrent hypoxia adjustment using carbogen and
The key prospective studies that investigated the role of nicotinamide (CON) in a phase 3 randomized trial. The
radical RT in localized MIBC using conformal techniques patients were treated with either 64 Gy in 32 fractions
are summarized in Table 4. 14-17 In a multicenter phase 3 over 6.5 weeks or 55 Gy in 20 fractions over 4 weeks. After
trial reported by James et al., 360 patients with MIBC 6 months, the complete cystoscopy response rate was 76%
12
were randomized to receive RT, with or without concurrent for RT alone and 81% for RT+CON (p=0.3). The 3-year OS
chemotherapy. The chemotherapeutic protocol included were 46% and 59% (p=0.04) for RT alone and RT+CON
mitomycin C (12 mg/m ) on day 1 and fluorouracil arms, respectively. RT+CON significantly decreased the
2
(500 mg/m of body-surface area per day), during fractions probability of death (p=0.03) and relapse (p=0.05) in the
2
1 – 5 and 16 – 20 of RT. The locoregional disease-free multivariate comparison. The therapy groups did not differ
survival (DFS) rates after 2 years were 54% (95% CI: 46 –
62) in the radiation group and 67% (95% CI: 59 – 74) in significantly in terms of GI or late urinary morbidity.
the CRT group. The HR for the CRT group was 0.68 (95% In a prospective phase 2 study, 50 MIBC patients
CI: 0.48 – 0.96, p=0.03), with a median FU of 69.9 months. received concurrent gemcitabine at 100 mg/m on days 1,
2

Volume 3 Issue 2 (2025) 80 doi: 10.36922/ARNM025090009