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Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer

AIM: To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. METHODS: Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMR...

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Autores principales: Whalley, D., Caine, H., McCloud, P., Guo, L., Kneebone, A., Eade, T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583158/
https://www.ncbi.nlm.nih.gov/pubmed/26407726
http://dx.doi.org/10.1186/s13014-015-0499-0
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author Whalley, D.
Caine, H.
McCloud, P.
Guo, L.
Kneebone, A.
Eade, T.
author_facet Whalley, D.
Caine, H.
McCloud, P.
Guo, L.
Kneebone, A.
Eade, T.
author_sort Whalley, D.
collection PubMed
description AIM: To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. METHODS: Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment. RESULTS: The median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed. Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone. CONCLUSION: IG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity.
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spelling pubmed-45831582015-09-26 Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer Whalley, D. Caine, H. McCloud, P. Guo, L. Kneebone, A. Eade, T. Radiat Oncol Research AIM: To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. METHODS: Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment. RESULTS: The median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed. Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone. CONCLUSION: IG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity. BioMed Central 2015-09-25 /pmc/articles/PMC4583158/ /pubmed/26407726 http://dx.doi.org/10.1186/s13014-015-0499-0 Text en © Whalley et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Whalley, D.
Caine, H.
McCloud, P.
Guo, L.
Kneebone, A.
Eade, T.
Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
title Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
title_full Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
title_fullStr Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
title_full_unstemmed Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
title_short Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
title_sort promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4583158/
https://www.ncbi.nlm.nih.gov/pubmed/26407726
http://dx.doi.org/10.1186/s13014-015-0499-0
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