Nav: Home

Study finds adaptive IGRT for bladder preservation clinically feasible

March 29, 2016

Fairfax, Va., March 29, 2016 - A prospective study examining a trimodality treatment approach in localized bladder cancer cases using adaptive image-guided, intensity-modulated radiation therapy (IG-IMRT) found that the bladder preservation rate at three years was 83 percent.

Approximately 150,000 people worldwide die every year as a result of urinary bladder cancer. Patients with moderately advanced bladder cancer typically undergo surgery with removal of the bladder resulting in the use of an external urine bag. The trimodality plan, which consists of the transurethral resection of the bladder tumor (TURBT), IG-IMRT and chemotherapy, was developed as a bladder conservation protocol to preserve bladder function with good oncological outcomes.

"Adaptive IGRT [with] plan-of-the-day approach for bladder preservation is clinically feasible, with good oncological outcomes and low rates of acute and late toxicities. Dose escalation is safe and possibly improves outcomes in bladder preservation," said Vedang Murthy, MD, radiation oncology, Tata Memorial Centre, Mumbai, India and lead author of the study, "Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for Urinary Bladder Cancer: A Prospective Study," published in the International Journal of Radiation Oncology * Biology * Physics (Red Journal).

"With adaptive IGRT, increasing the dose becomes possible, and serious side effects may be kept low, ensuring a good quality of life for our patients," Dr. Murthy said.

The study looked at 44 patients between August 2008 and August 2014. Thirty nine (88 percent) patients were male and five (11 percent) were female, ranging in ages from 55 to 72. Eighty-eight percent of patients had stage 2 disease. Patients underwent maximal safe resection of bladder tumor and concurrent platinum-based chemotherapy, and those with large tumors were offered induction chemotherapy.

RT planning was done using either three (n=34) or six (n=10) non-concentrically grown planning target volumes (PTV). Patients received 64 Gy in 32 fractions to the whole bladder and 55 Gy to the pelvic nodes. If appropriate, they received a simultaneous integrated boost to the tumor bed to 68 Gy. Daily megavoltage imaging was used to find the most appropriate PTV encompassing bladder for the particular day with the plan-of-the-day approach.

At six to ten weeks post-treatment, all patients had a complete response. The study had a median follow-up of 30 months. Overall survival at the last follow up was 77 percent (34 patients). Among those who died, three died from comorbidities and were disease free at the time of death.

The three-year locoregional control (LRC), disease-free survival and overall survival (OS) rates were 78 percent, 66 percent and 67 percent, respectively. Rates of LRC and OS were better in patients who received dose escalation. Acute and late Radiation Therapy Oncology Group (RTOG) grade 3 genitourinary toxicity was seen in five (11 percent) and two (four percent) patients, respectively. No acute or late RTOG grade 3 or higher gastrointestinal toxicity occurred.

"Adaptive RT (ART) further helps in reduction of doses to normal tissues and improves accuracy of delivery," Dr. Murthy said. "These procedures, in theory, should result in less acute and late toxicity, while allowing for dose escalation to gross tumor to improve outcomes."

"Although a number of investigators have conceived and developed a variety of ART techniques, there are few clinical outcome data to validate this dosimetric concept. The present proof-of-concept prospective study was conducted with the aim of establishing the safety, ef?cacy, and feasibility of IG-IMRT-based ART in clinical practice," he said.

More follow-up with larger groups of patients is needed to establish the novel technique as the standard, Dr. Murthy said, but results from the study have shown the possibilities of ART in bladder cancer patients.

"These results provide proof of concept of using adaptive IGRT in the clinic," Dr. Murthy said. "This will hopefully lead to more and more suitable patients undergoing bladder preservation around the world."
-end-
For more information, contact ASTRO's Press Office at press@astro.org. For the study abstract, visit http://www.redjournal.org/article/S0360-3016(15)03321-0/abstract. For more information about the Red Journal, visit http://www.redjournal.org.

ABOUT ASTRO

ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology * Biology * Physics, Practical Radiation Oncology and Advances in Radiation Oncology; developed and maintains an extensive patient website, RT Answers; and created the Radiation Oncology Institute, a nonprofit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit http://www.astro.org.

American Society for Radiation Oncology

Related Radiation Oncology Articles:

Cloudy with a chance of radiation: NASA studies simulated radiation
NASA's Human Research Program (HRP) is simulating space radiation on Earth following upgrades to the NASA Space Radiation Laboratory (NSRL) at the US Department of Energy's Brookhaven National Laboratory.
Scientific advances in thoracic oncology in 2016 highlighted by the IASLC
Capturing and summarizing the remarkable progress in lung cancer prevention, diagnosis, staging and treatment in 2016, the International Association for the Study of Lung Cancer (IASLC) announces the second annual publication of 'Scientific Advances in Thoracic Oncology,' available online now and in the August 2017 issue of the IASLC's Journal of Thoracic Oncology (JTO).
Announcing the inaugural online immuno-oncology symposium
Oncology Central is delighted to be hosting, 'Practical clinical aspects of immuno-oncology' a two-day online symposium exploring the latest developments in cancer immunotherapy, chaired by Professor Angus Dalgleish (St.
William Small, Jr., M.D., editor of new edition of classic radiation oncology textbook
William Small, Jr., M.D., chair of Loyola Medicine's radiation oncology department, is editor of a revised third edition of a classic reference in radiation oncology.
Media can register now for ESTRO 36 - Europe's largest congress on radiation oncology
Journalists can register now for ESTRO 36 - Europe's largest congress on radiation oncology, organised by the European Society for Radiotherapy and Oncology (ESTRO).
CancerLinQ partners with premier radiation oncology society
CancerLinQ LLC and the American Society for Radiation Oncology (ASTRO) are partnering to bring radiation oncology expertise to CancerLinQ and improve the care of cancer patients nationwide.
MD Anderson designated first Project ECHO superhub for oncology
Recognizing a critical need to address disparities in cancer care, The University of Texas MD Anderson Cancer Center has been designated as an ECHO superhub for oncology by the ECHO Institute at the University of New Mexico Health Science Center (UNMHSC).
ESMO announces new award for achievements in immuno-oncology
ESMO announces new award honoring individuals for outstanding achievements in the area of cancer immunotherapy and the launch of the ESMO Immuno-Oncology Congress.
European experts highlight the potential of xenografts in personalized oncology
European research lays the foundation for the development of new and ambitious research projects with xenografts derived from patients, preclinical models with great potential to advance research and treatment in cancer.
Special issue of Future Oncology highlights the field of Psycho-oncology
The Future Science Group (FSG) published journal, Future Oncology, has released a special issue that examines the field of psycho-oncology, which aims to bring together the biomedical and psychosocial aspects of cancer care.

Related Radiation Oncology Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...