ABSTRACT
Bladder cancer is the 6th most common cancer worldwide and contributes significant excess mortality and morbidity. It often presents at a late stage when it is incurable, and the prognosis is poor. The local symptoms of bladder cancer-including haematuria, dysuria, frequency, nocturia and pain, have significant effects on quality of life and may require frequent inpatient admissions. As a palliative treatment, radiotherapy can be uniquely useful in providing targeted long term symptomatic control, although this must be balanced against the potential of causing toxicity. A variety of radiotherapy protocols have been developed for managing these symptoms. The results of several studies show that radiotherapy delivered in a hypofractionated regime (21 Gy in 3 fractions) can provide relief of these symptoms within a few weeks. Other commonly used regimes include 35 Gy in 10 fractions, 30 Gy in 5 fractions, a once weekly 36 Gy in 6 fractions, and a single 8 Gy fraction. In the palliative setting symptom resolution lasts for the majority of the patients remaining lifespan. Benefit is particularly clear for symptomatic haematuria and in these patients even single doses may provide rapid benefit. To maximise benefit from radiotherapy, studies are urgently needed to better estimate the prognosis of patients presenting with bladder cancer.
Subject(s)
Urinary Bladder Neoplasms , Humans , Pain , Palliative Care , Prognosis , Quality of Life , Radiotherapy , Urinary Bladder Neoplasms/radiotherapyABSTRACT
Radiotherapy is rarely used for T1 bladder cancer. We discuss the potential reasons for this, the current evidence, and make suggestions for future research. PATIENT SUMMARY: Despite its success in muscle-invasive disease, radiotherapy is rarely used for non-muscle-invasive bladder cancer. We discuss the current evidence and suggest that, with further research, radiotherapy holds much promise as a bladder-preserving strategy.
Subject(s)
Neoplasm Recurrence, Local , Radiotherapy/methods , Urinary Bladder Neoplasms , Combined Modality Therapy/methods , Humans , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm Staging , Treatment Outcome , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/radiotherapyABSTRACT
Immune-related radiological and biomarker monitoring in cancer immunotherapy trials permits interrogation of efficacy and reasons for therapeutic failure. We report the results from a cross-sectional analysis of response monitoring in 685 T-cell checkpoint-targeted cancer immunotherapy trials in solid malignancies, as registered on the U.S. National Institutes of Health trial registry by October 2016. Immune-related radiological response criteria were registered for only 25% of clinical trials. Only 38% of trials registered an exploratory immunological biomarker, and registration of immunological biomarkers has decreased over the last 15 years. We suggest that increasing the utilization of immune-related response monitoring across cancer immunotherapy trials will improve analysis of outcomes and facilitate translational efforts to extend the benefit of immunotherapy to a greater proportion of patients with cancer.
