Predicting Survival After Whole-brain Irradiation for Cerebral Metastases in Patients with Cancer of the Bladder.

BACKGROUND/AIM: This study aimed to create a predictive tool for estimating the remaining lifespan of patients after whole-brain irradiation (WBI) for cerebral metastases from bladder cancer. PATIENTS AND METHODS: In 34 of these patients clinical parameters were analyzed for survival including age at start of WBI, gender, Karnofsky score, number of cerebral metastases and involvement of extra-cranial sites of metastasis. RESULTS: Involvement of extra-cranial sites (14%) and Karnofsky score (9%) showed the greatest difference regarding 6-month survival and were considered for the tool. Points were assigned based on the following: no involvement of extra-cranial sites=1 point, involvement of extra-cranial sites=0 points, Karnofsky score ≥70=1 point, Karnofsky score ≤60=0 points. Patients' scores were 0, 1 or 2 points with 6-month survival rates of 13%, 27% and 50%, respectively. CONCLUSION: Based on two clinical parameters, a tool was developed that may help estimate the lifespan of patients irradiated for cerebral metastases from bladder cancer.

Factors Impacting the Overall Survival of Patients Irradiated for Invasive Carcinoma of the Urinary Bladder.

BACKGROUND/AIM: To contribute to personalisation of treatment for patients with carcinoma of the urinary bladder, 11 factors were analyzed for survival. PATIENTS AND METHODS: Data from 61 patients receiving definitive irradiation for carcinoma of the urinary bladder were retrospectively evaluated, namely gender, age, T-stage, N-stage, grading, pack years, smoking during irradiation, upfront transurethral resection of the bladder tumour (TURBT), equivalent dose in 2-Gy fractions (EQD2), chemotherapy and Karnofsky performance score (KPS). RESULTS: On univariate analysis, female gender (p=0.007), <40 pack years (p=0.029), not smoking during irradiation (p=0.037), TURBT (p=0.007) and KPS >70 (p<0.001) led to improved survival; EQD2 >55 Gy showed a trend (p=0.065) for such association. On Cox regression, gender [risk ratio (RR)=2.81; p=0.039], TURBT (RR=4.44; p=0.033) and KPS (RR=3.45; p=0.018) remained significant. CONCLUSION: This study identified independent predictors of survival in patients irradiated for carcinoma of the urinary bladder and contributes to creation of personalised treatment programs.

A New Prognostic Tool for Patients Undergoing Radiotherapy plus Upfront Transurethral Resection for Bladder Cancer.

AIM: To create a tool to estimate overall survival (OS) of patients with non-metastatic bladder cancer. PATIENTS AND METHODS: Eight parameters were retrospectively evaluated for OS in 42 patients undergoing radiotherapy and upfront transurethral resection for bladder cancer. The prognostic tool included those parameters that were significant on both univariate and multivariate analyses. The tool was based on the 3-year OS rate divided by 10. Patient scores were calculated by adding the points for each significant parameter. RESULTS: On univariate analysis, 3-year OS was associated with gender (p=0.017), pack years (p=0.009) and Karnofsky performance score (KPS) (p<0.001). On Cox regression, pack years (p=0.007) and KPS (p<0.001) remained significant and were incorporated into the tool. Three prognostic groups were designated with 6, 10-11 and 15 points with 3-year OS-rates of 0%, 34% and 83%, respectively (p<0.001). CONCLUSION: A tool was developed to estimate the OS of patients with bladder cancer to improve individualization of treatment.

Simplified Comorbidity Score and Eastern Cooperative Oncology Group Performance Score Predicts Survival in Patients Receiving Organ-preserving Treatment for Bladder Cancer.

BACKGROUND/AIM: This study investigated three comorbidity scales and the Eastern Cooperative Oncology Group performance score (ECOG-PS) for survival in patients receiving local irradiation for bladder cancer. PATIENTS AND METHODS: Sixty-four patients receiving organ-preserving radio-chemotherapy or radiotherapy for urinary bladder cancer were retrospectively evaluated. Charlson Comorbidity Index (CCI), Simplified Comorbidity Score (SCS), Age-Adjusted Charlson Comorbidity Index (AAC) and ECOG-PS were analyzed for associations with survival. RESULTS: Patients with a SCS of 0-7 points had a significantly better survival than those with 8-18 points (p=0.018). Five-year survival rates were 64% and 32%, respectively. Patients with ECOG-PS of 0-1 had a significantly better 5-year survival than patients with ECOG-PS of 2-3 (64% vs. 0%, p<0.001). For CCI (p=0.16) and AAC (p=0.49), a significant association with survival was not observed. CONCLUSION: SCS and ECOG-PS were significantly associated with survival in patients irradiated for bladder cancer and can help estimate the prognoses of these patients.

Radiotherapy of Primary or Recurrent Bladder Cancer in the Very Elderly.

AIM: The number of very elderly patients with cancer is growing and requires particular attention. The role of organ-sparing irradiation in patients with bladder cancer aged ≥80 years was investigated. PATIENTS AND METHODS: In 29 very elderly (≥80 years) patients irradiated for bladder cancer, 12 characteristics were analysed for survival: indication, gender, age, Karnofsky performance score (KPS), T-/N-category, tumour grade, pack years, smoking during irradiation, radiation dose, interruption of irradiation >5 days and concurrent chemotherapy. RESULTS: On univariate analysis, primary treatment (p=0.001), KPS >70 (p=0.026) and not smoking during radiotherapy (p<0.001) were associated with better survival. A strong trend for such association was observed for female gender (p=0.054), <40 pack years (p=0.064) and concurrent chemotherapy (p=0.061), and a trend for no interruption of irradiation (p=0.09). On multivariate analysis, primary treatment (p=0.006) and not smoking during radiotherapy (p=0.038) maintained significance. CONCLUSION: Very elderly patients irradiated for bladder cancer may benefit from concurrent chemotherapy. Smoking during irradiation and interruptions of irradiation should be avoided.

A New Prognostic Instrument Specifically Designed for Patients Irradiated for Recurrent Carcinoma of the Bladder.

BACKGROUND/AIM: To develop an instrument that could estimate the 1-year survival probabilities of patients irradiated for recurrent carcinoma of the bladder. PATIENTS AND METHODS: Thirty patients irradiated for locally recurrent bladder carcinoma were included. Six pre-treatment factors [age, gender, Karnofsky score (KPS), pack years, grading and time between cancer diagnosis and radiotherapy] were evaluated for survival. Of those factors showing a trend or significance on multivariate analysis, 1-year survival rates were added. RESULTS: On multivariate analysis, KPS was significant (hazard ratio(HR)=3.76, p=0.008), age showed a trend (HR=2.04, p=0.13). Patient scores were five, nine, ten or fourteen points with 1-year survival rates of 13%, 25%, 57% and 82% (p=0.003). Three groups were designed, A (5-9 points), B (10 points) and C (14 points) with 1-year survival rates of 17%, 57% and 82% (p=0.001). CONCLUSION: This score, including three groups with different 1-year survival probabilities, can aid physicians treating patients with recurrent bladder carcinoma.

A Survival Score for Patients Assigned to Palliative Radiotherapy for Metastatic Bladder Cancer.

AIM: To create a survival score for patients with metastatic bladder cancer. PATIENTS AND METHODS: In 46 irradiated patients, six characteristics were evaluated for their association with survival: Age, gender, Karnofsky performance scale, initial stage (American Joint Committee on Cancer), number of metastatic sites, and interval between bladder cancer diagnosis and palliative radiotherapy. Characteristics showing a trend (p<0.15) were incorporated into the score. Six-month survival rates were divided by 10. Patients' scores were derived by totaling the scores of these characteristics. RESULTS: Performance scale (p=0.14), stage (p=0.055) and number of metastatic sites (p=0.10) showed a trend for association with survival. Patients' scores were 6, 7, 8, 10 or 12 points, with corresponding 6-month survival rates of 20%, 0%, 0%, 46% and 45% (p=0.038). Two groups were created, with 6-8 and with 10-12 points, with 6-month survival rates of 9% and 46% (p=0.002), respectively. CONCLUSION: A new survival score was developed. Patients with 6-8 points should receive less aggressive treatments for metastatic bladder cancer. Those with 10-12 points may receive more intensive approaches.

Concurrent Chemotherapy Improves the Overall Survival of Patients Irradiated for Locally Recurrent Bladder Cancer.

AIM: To investigate the predictive value of several factors, including concurrent chemotherapy, for overall survival of patients irradiated for locally recurrent bladder cancer. PATIENTS AND METHODS: Thirty patients irradiated for local recurrence of bladder cancer were included; 14 received concurrent chemotherapy. Ten factors were analyzed for overall survival: gender, age, period from bladder cancer diagnosis to irradiation of local recurrence, Karnofsky performance scale, tumour grading, pack-years smoked, smoking during radiotherapy, radiation dose, interruption of radiotherapy and concurrent chemotherapy. RESULTS: On univariate analyses, significantly longer overall survival was found for those with age ≤76 years (p=0.024), better performance status (p<0.001) and those treated with concurrent chemotherapy (p<0.001). On Cox regression analysis, concurrent chemotherapy remained significantly associated with survival (risk ratio 3.82, p=0.013); a trend for association was found for performance status (risk ratio 2.50, p=0.076). CONCLUSION: Addition of concurrent chemotherapy to radiotherapy for locally recurrent bladder cancer resulted in improved overall survival. Concurrent radiochemotherapy should be considered when this is clinically reasonable for such patients.

Chemoradiation Including Paclitaxel for Locally Recurrent Muscle-invasive Bladder Cancer in Elderly Patients.

BACKGROUND/AIM: To evaluate outcomes and toxicities of chemoradiation with a less intensive paclitaxel regimen for locally recurrent bladder cancer. PATIENTS AND METHODS: Three elderly patients received simultaneous chemoradiation for recurrent muscle-invasive bladder cancer. Chemotherapy included two courses (three times 25 mg/m2 over 1.5 weeks) of paclitaxel. Radiotherapy doses were 59.4 Gy to the bladder and 50.4 Gy to regional lymph nodes. Survival, local control and toxicities were retrospectively evaluated. RESULTS: One patient died after 71 months, two were alive after 69 and 98 months, respectively. No local recurrence was not observed. Five-year survival and local control rates were 100%. Two patients experienced grade 1 acute dysuria, one patient grade 1 diarrhea. Late toxicities were also mild; two patients had grade 1 dysuria. CONCLUSION: Chemoradiation with a less intensive paclitaxel regimen resulted in excellent 5-year results and was very well tolerated. It may be a reasonable option for elderly patients who cannot tolerate more intensive approaches.

Predicting Survival After Irradiation of Metastases from Transitional Carcinoma of the Bladder.

AIM: For patients with metastatic bladder cancer, radiotherapy is a good option to control symptoms and improve outcomes. Potential prognostic factors for survival including the radiation dose were investigated. PATIENTS AND METHODS: Ten factors were evaluated in 63 patients for association with survival after irradiation namely age, gender, performance status, initial T-category, initial N-category, metastases at initial diagnosis, number of metastases, metastatic sites, radiation dose and time from diagnosis of metastases to irradiation. RESULTS: On univariate analysis, survival was negatively associated with Karnofsky performance score (KPS) ≤70 (p=0.033), initial N-category ≥1 (p=0.026) and radiation doses given as equivalent dose in 2-Gy fractions (EQD2) <20 Gy. Doses >30 Gy were slightly superior to 20-30 Gy. On multivariate analysis, EQD2 (p=0.015) maintained its significance; a trend was found for N-category (p=0.063) and KPS (p=0.073). CONCLUSION: Predictors for survival after irradiation of metastases from bladder cancer were identified. Radiation doses ≥20 Gy should be used.