ASCO GU 2017: Optimizing Outcomes in Muscle-Invasive and Metastatic Bladder Cancer - Radiation Oncology Perspective - Session Highlights

Orlando, Florida USA ( Ann Henry, University of Leeds, discussed bladder preservation strategies. Trimodality treatment with radical transurethral resection of bladder tumor (TURBT), chemotherapy and radiotherapy can have comparable outcomes to radical cystectomy. Using the following case she discussed trimodality treatment consideration in the management of bladder cancer: 75 year old female with a 3cm bladder tumor with HG pT2, no carcinoma in-situ (CIS). Optimal candidates for bladder preservation are good performance status, good urinary function, maximal TURBT, no prior pelvic radiotherapy, absence of CIS and/or hydronephrosis and accepting of regular long term follow-up.

The above patient opts for bladder preservation. Neoadjuvant chemotherapy in trimodality has to be derived from neoadjuvant trials among radical cystectomy literature noting approximately 5% improved survival. Cisplatin is the most effective drug in treating bladder cancer, however, cisplatin can be associated with significant toxicity. There is also interest in determining which patients respond to chemotherapy with non-responders best suited to undergo radical cystectomy. Split phase chemoradiotherapy has been extensively studies by colleagues at Massachusetts General Hospital in Boston. In the split phase regimen, pending response to chemotherapy after radical TURBT, patients undergo radiotherapy with non-responders recommended to undergo radical cystectomy. It should be noted and the split course treatment may result in continued/accelerated proliferation of clonogenic tumor cells.

In a multi-center study, improved outcomes with radio-sensitizers versus radiotherapy alone with 1/3 decrease recurrence, improved survival and lower salvage cystectomy among those treated with chemoradiotherapy than radiotherapy alone, respectively. Accurate surgical and radiological staging are paramount to determining the appropriate treatment for each patient.

Presenter: Ann Henry, University of Leeds

Contributed by Stephen B. Williams, MD, Assistant Professor, Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX and Ashish M. Kamat, MD, Professor, Department of Urology, The University of Texas MD Anderson, Houston, TX

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA