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Category: Volume 08 Issue 04 April 2020
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Title: Bladder Cancer: is Radiotherapy being Underutilized?

Authors: Dr P.Sridhar, Dr Vijay C.R., Dr Rasla Parween, Dr Mahantesh A.S, Dr Murali Krishna, Dr Lokesh Vishwanath, Dr Naveen Thimmiah

 DOI: https://dx.doi.org/10.18535/jmscr/v8i4.26

Abstract

   

Background of the Study: Bladder cancer is the 2nd most common Genitourinary cancer. There are 424082 male Bladder cancer cases and 125311 female bladder cancer cases worldwide. In India, there were 14729 male and 4197 female patients who had Bladder cancer. According to HBCR (2016) there were 71 male and 21 female bladder cancer patients. Radical cystectomy has been considered as the gold standard treatment of choice and only curative therapy for Bladder cancer, thereby underutilizing the trimodality therapy consisting of Transurethral Resection of Bladder Tumor (TURBT) and Chemoradiation,which helps in maintaining patient’s native bladder and improving quality of life. Radical cystectomy with pelvic node dissection is associated with potential morbidity and can be avoided in selected group of patients. This study is to assess the Urinary bladder cases who underwent treatment and the outcomes of Bladder Preservation Therapy (BPT) and quality of life.

Materials and Methods: Bladder cancer patients who reported to Department of Radiation Oncology in Kidwai Memorial Institute of Oncology were analyzed from January 2019 to February 2019. A total of 17 patients were referred for Radiotherapy treatment which included Haemostatic Radiotherapy, Adjuvant Radiotherapy, Radical Radiotherapy, Palliative Radiotherapy. All the Patients underwent basic investigations and work up was done. Based on the Clinical stage of disease and general condition of Patients, Radiotherapy was planned. Conformal Radiotherapy technique was delivered and Clinical outcomes were analysed.   

Results: 4 patients received hemostatic radiotherapy and had good bleeding control within 24 to hours, 4 patients received Radical radiotherapy of which 2 patients had stable disease and 2 patients had complete response. 2 patients underwent Trimodality treatment and 1 patient received adjuvant radiotherapy, all of them had no evidence of disease on cystoscopy. 3 patients received Palliative radiotherapy and had good pain relief from bone metastasis. About 76% of patients had gastrointestinal toxicity (grade.1- 46% and grade.2- 30%) and 70% of patients had genitourinary toxicity (grade.1- 30% and grade.2- 40%).

Conclusions: Trimodality therapy provides equal oncologic outcomes and reduces the morbidity associated with radical cystectomy. Selection of cases is the most crucial step for better tumour control and improving quality of life and hence Trimodality therapy must be judiciously advocated to the ideal bladder cancer cases. Organ preservation therapy for bladder cancer is an effective alternate approach in specific subset of patients. The need for multidisciplinary clinics must be emphasized and each case must be dealt critically for bladder preservation therapy. Radical cystectomy must be reserved for recurrent cases and non-responders of chemoradiotherapy. The optimal usage of radiation technique, fractionation schedule, chemotherapeutic agent individualized for the patients and also targeted therapy will definitely bring about better results in management of bladder cancer.

Keywords: Bladder Preservation Therapy, Muscle-Invasive Bladder Cancer, Radical Cystectomy, Image Guided Radiotherapy, Transurethral Resection of Bladder Tumour.

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Corresponding Author

Dr Mahantesh A.S

Assistant Surgeon, Kidwai Memorial Institute of Oncology, Bangalore-29, India