Page 89 - ARNM-3-2

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

Table 4. Prospective studies of conformal radiotherapy with concurrent chemotherapy in muscle‑invasive bladder cancer using
conformal techniques
Study, patient number (n), and RT dose Chemotherapy/ Toxicity Survival
study type radiosensitizing
regime
James et al., n=360, phase 3 RCT 64 Gy in 32 fractions for Mitomycin/ Grade 3 – 4 adverse events 2-year survival rate of 67% for CRT,
12
of RT compared to CRT 6.5 weeks or 52.5 Gy in 20 fluorouracil for RT (27.5%) and CRT compared to 54% for RT
fractions for 4 weeks (36.0%) HR: 0.68; 95% CI: 0.48 – 0.96; P=0.03
Hoskin et al. n=333, phase 64 Gy in 32 fractions for Carbogen/ No difference in grade 3 – 4 3-year survival rate of 59% for
16
3 RCT of RT compared to 6.5 weeks or 52.5 Gy in 20 nicotinamide of GI or GU toxicity RT+CON, compared to 46% for RT
RT+CON fractions for 4 weeks (p=0.04)
Choudhury et al., n=50, phase 2 55 Gy in 20 fractions for Gemcitabine Four patients could not 3-year survival rate of 75%
17
prospective single-arm study 4 weeks complete chemotherapy due
to bowel toxicity
15
Sabaa et al., n=104, phase 2 Conventional fractionation Gemcitabine/ No significant grade 3 – 4 5-year survival rate of 59.4%
prospective single-arm study 64 Gy in 32 fractions cisplatin toxicity was observed and all
patients completed treatment
as planned
Abbreviations: CI: Confidence interval; CON: Carbogen and nicotinamide; CRT: Chemoradiotherapy; GI: Gastrointestinal; GU: Genitourinary;
HR: Hazard ratio; RCT: Randomized controlled trial; RT: Radiotherapy.

8, 15, and 22, along with a 28-day RT regimen consisting a median OS of 1.55 years (95% CI: 1.35 – 1.82 years).
of 55 Gy in 20 fractions. All patients completed RT, and When compared to palliative care, undergoing radical
46 (92%) of them were able to complete all four gemcitabine treatments was associated with an enhanced OS rate
cycles. Two patients (4%) stopped their treatment after two (HR: 0.32; 95% CI: 0.23 – 0.44; p<0.001). Patients who
cycles, while two (4%) stopped after three cycles. Out of had radical treatment (n = 163) either underwent radical
47 patients who had a post-treatment cystoscopy, 44 (88%) cystectomy (n = 76) or received a radical dose of RT
of them had a full endoscopic response. Out of 36 patients (n = 87). The multivariate analysis revealed no correlation
who were still alive at the median FU of 36 months (range: between the choice of radical treatment and OS (HR: 0.94;
15 – 62 months), 32 (64%) of them had a functional 95% CI: 0.63 – 1.41; p=0.76) or PFS (HR: 0.74; 95% CI:
and intact bladder. Two (4%) patients died as a result of 0.50 – 1.08; p=0.12). Swinton et al. recommended that all
treatment-associated complications, five patients (10%) patients with node-positive MIBC should have access to
died due to intercurrent disease, and seven patients (14%) bladder-sparing TMT treatment due to limited prognosis
died due to metastatic MIBC. Cystectomy was performed and the recognized morbidities associated with radical
on three patients (6%) due to recurrent illness and one cystectomy. Tan et al. reported on a phase 2 prospective
9
(2%) due to toxicity. The OS was 75%, and cancer-specific study of intensity-modulated pelvic node and bladder RT,
survival was 82% after 3 years. 15 conducted to assess the feasibility of delivering IMRT to
Multiple single-arm prospective studies in RT oncology treat the bladder and pelvic nodes in patients with node-
have evaluated the role of radical RT in conjunction with positive or high-risk node-negative bladder cancer. In this
concurrent cisplatin-based chemotherapy and reported a study, they delivered 64 Gy in 32 fractions to the tumor
3-year survival rate ranging from 60% to 80%. Based on bed, 60 Gy in 32 fractions to the positive nodes, and 52 Gy
this evidence, concurrent CRT is currently considered the in 32 fractions to the bladder, excluding the tumor bed
gold standard of care for patients undergoing TMT as part and elective nodes. The trial reported acute grade 1 and
of a bladder preservation strategy. 2 GI and genitourinary toxicities in 81.1% and 70.6% of
patients, respectively, and grade 3 toxicities of 5.4% and
Few studies have investigated the role of RT for patients 20.6%, respectively. Grade 3 late toxicities were 5%, with
with advanced bladder cancer and node-positive disease. one patient reporting grade 3 cystitis and hematuria. No
A multicenter retrospective study looking at survival grade 3 or 4 toxicities were reported in year 2. The median
outcomes in patients with node-positive MIBC was 1-, 2-, and 5-year pelvic relapse-free survival rates were
reported by Swinton et al. Participating UK oncology 55%, 37%, and 26%, respectively. The median OS was
18
centers that offered both TMT and radical cystectomy 1.9 years (95% CI: 1.1 – 3.8), with 1-, 2-, and 5-year OS
provided data on patients (n = 287) with clinically rates of 68%, 50%, and 34%, respectively. Sondergaard
node-positive, non-metastatic MIBC. All patients had et al. treated 16 patients with 60 Gy to the bladder and
11

Volume 3 Issue 2 (2025) 81 doi: 10.36922/ARNM025090009