Introduction and Objectives
Neoadjuvant chemotherapy (NAC) and a radiosensitiser with radiotherapy (CRT) should be offered to suitable patients with non-metastatic muscle-invasive bladder cancer as per NICE guidance as they have been shown to improve outcomes. Transurethral resection of bladder tumour (TURBT) is traditionally classed as the first definitive treatment, rather than a diagnostic process but leads to concern that patients ‘fall off’ the pathway after TURBT, leading to a delay in starting therapy.
Methods
Retrospective data from bladder cancer patients treated with radiotherapy over a 2-year period (12/2015-11/2017) in a large UK centre are presented.
Results
Fifty-eight patients were identified. 83% (48/58) were male, median age 76 years (range 52-88). Median time from TURBT to radiotherapy was 95 days (range 41-242).
12% (7/58) received NAC, 41% (24/58) CRT (Mitomycin-C and 5FU) and 59% (34/58) had radiotherapy alone. All patients received 55Gy in 20 fractions over 4-weeks. Reasons documented for not giving CRT: comorbidities and age (67%, 23/34); not documented (33%, 11/34).
Check cystoscopies post radiotherapy were performed in 74% (43/58): median time point 4.8 months (range 3.4 – 16.4): 76.7% (33/43) no abnormality; 23.3% other (CIS (2); invasive disease (2); and data missing (6)). For the 15 pts who did not have cystoscopy, 7 patients had CT: SD/PR (4/7), and PD (3/7). In 8 patients bladder was not evaluated by CT/cystoscopy within 12 months: deceased (4), missing data (2), other cancers (2)). Overall responders to treatment 63.8% (37/58) at time of first assessment: cystoscopy (33), CT (4).
58.6% (34/58) of patients are alive after median follow-up 24.7 months (range 2.8 – 40.9 months). Two-year overall survival is 73% (38/52). Median time to death 13.3 months (range 4.9 – 40.7, n=24). In the CRT group, 2-year DFS 41% and RT group 42%.
Conclusions
Reducing the time to radiotherapy from TURBT is being reviewed in the MDT. A substantial number of patients did not receive either NAC or a radiosensitiser which may account for inferior outcomes compared with trials reported in the literature (BC2001 and BCON). However, this represented real-world data where there were comorbidities in many patients. Gemcitabine is an alternative radiosensitiser which has recently been adopted in this centre with the aim of increasing the number of patients receiving concurrent treatment and outcome data will be presented in the future.
