The Christie NHS Foundation Trust A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer A. Choudhury*, R. Swindell*, J. P. Logue*, P. A. Elliott*, J.E. Livsey*, P. Symonds # , J. P. Wylie*, N.W. Clarke*, A. E. Kiltie $ , R.A. Cowan* *The Christie, Wimslow Road, Manchester M20 4BX, # Leicester Royal Infirmary, Leicester LE1 5WW, $ The Gray Institute, Oxford OX3 7DQ J Clin Oncol. 2011 Feb 20;29(6):733-8. Epub 2011 Jan 4.
27
Embed
A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer
This presentation forms a part of a Virtual Edition on Radiotherapy for bladder cancer on www.bjui.org.
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
The Christie NHS Foundation Trust
A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent
gemcitabine in muscle-invasive bladder cancer
A. Choudhury*, R. Swindell*, J. P. Logue*, P. A. Elliott*, J.E. Livsey*, P. Symonds#, J. P. Wylie*, N.W. Clarke*, A.
E. Kiltie$, R.A. Cowan*
*The Christie, Wimslow Road, Manchester M20 4BX, #Leicester Royal Infirmary, Leicester LE1 5WW, $The Gray Institute, Oxford OX3 7DQ
J Clin Oncol. 2011 Feb 20;29(6):733-8. Epub 2011 Jan 4.
The Christie NHS Foundation Trust
Outline
• Background
• Results of phase II GemX study
• Future directions
The Christie NHS Foundation Trust
Introduction
• Radical treatment for MIBC can be radiotherapy or surgery
• Survival is ~50% at 5 years for either modality.
The Christie NHS Foundation Trust
Comparison of RT and surgery: Disease-specific survival
Kotwal et al: Int. J. Radiation Oncology Biol. Phys., Vol. 70, No. 2, pp. 456–463, 2008
The Christie NHS Foundation Trust
Prognostic factors
• Age/performance status
• Stage
• Renal function
• Hydronephrosis
• Unifocal disease – no widespread CIS
The Christie NHS Foundation Trust
Patient selection for radical radiotherapy treatment
• Localised-disease muscle-invasive cancer
• Maximal Trans-Urethral Resection of Bladder
• Good bladder function
• WHO PS ≤3
The Christie NHS Foundation Trust
Conventional whole bladder RT-The Christie1
• Maximal TURBT
• Staged using MRI pelvis and CXR
• Whole Bladder RT: 52.5 Gy/20# n=60
(1) Cowan et al. Int. J. Radiation Oncology Biol. Phys., Vol. 59, No. 1, pp. 197–207, 2004
The Christie NHS Foundation Trust
Christie series
Cowan. R, McBain. C. et al. Int. J. Radiation Oncology Biol. Phys., Vol. 59, pp. 197-207, 2004
5yr Survival
OS: 58%
DSS: 65%
The Christie NHS Foundation Trust
Chemoradiation
• Chemoradiation increases the rate of bladder preservation and local control compared to radiotherapy alone
• Effect on survival is unclear, although no detriment
• The optimal chemotherapy regimen is unknown
The Christie NHS Foundation Trust
Results of Canadian Trial
Pelvic-recurrence free survivalOverall survival
Coppin et al: Journal of Clinical Oncology, Vol 14, No 11 (November), 1996: pp 2901-2907
The Christie NHS Foundation Trust
Summary of bladder preservation studies to 2010
Rene et al. Curr Oncol > v.16(4); Aug 2009
The Christie NHS Foundation Trust
Rationale for GemX
• Gemcitabine is effective in bladder cancer and is a potent radiosensitizer in vitro (1).
• Christie phase I study found acceptable toxicity when combined with hypofractionation (2)
(1) Sangar et al. Br J Cancer. 2004 Jan 26;90(2):542-8. (2) Sangar et al. Int. J. Radiation Oncology Biol. Phys., Vol. 61, No. 2, pp. 420–425, 2005