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Strahlentherapie und Onkologie

, Volume 186, Issue 10, pp 565–571 | Cite as

A Comparison of Radiotherapy with Radiotherapy plus Surgery for Brain Metastases from Urinary Bladder Cancer

Analysis of 62 Patients
  • Emmanouil Fokas
  • Martin Henzel
  • Rita Engenhart-Cabillic
Original Article

Purpose:

To evaluate the role of radiotherapy (RT) and prognostic factors in 62 patients with brain metastases from transitional cell carcinoma (TCC) of the urinary bladder.

Patients and Methods:

62 patients received either RT (n = 49), including whole-brain radiotherapy (WBRT) and/or stereotactic radiosurgery (SRS), or surgery (OP) combined with WBRT (n = 13). Overall survival (OS), intracerebral control (ICC) and local control (LC) were retrospectively analyzed. Six potential prognostic factors were assessed: age, gender, number of brain metastases, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from tumor diagnosis to RT.

Results:

Median OS and ICC for the entire cohort were 9 and 7 months. No significant difference between RT and OP + RT was found for OS (p = 0.696) and ICC (p = 0.996). On multivariate analysis, improved OS was associated with lack of extracerebral metastases (p < 0.001) and RPA class (p < 0.001), and ICC with the latter (p < 0.001). SRS-incorporating RT resulted in 1-, 2-, and 3-year LC probability of 78%, 66%, and 51%. No association between LC and any of the potential prognostic factors was observed. The results of the subgroup RPA class analyses were similar to the entire cohort.

Conclusion:

Patient outcome for the RT-alone arm was not significantly different from OP + RT. SRS-incorporating treatment offers excellent LC rates. RPA class and the presence of extracerebral metastases demonstrated a significant prognostic role for survival. The latter should be used as stratification factors in randomized trials and can help define the cohort of patients that may benefit from more aggressive therapies.

Key Words:

Brain metastases Radiosurgery Bladder cancer Prognostic factors 

Vergleich von Strahlentherapie und Strahlentherapie plus Chirurgie bei Gehirnmetastasen eines Harnblasenkarzinoms

Analyse von 62 Patienten

Ziel:

Die Rolle der Strahlentherapie (RT) von Patienten (n = 62) mit Gehirnmetastasen eines Urothelkarzinoms der Harnblase sowie prognostische Faktoren wurden ermittelt.

Patienten und Methodik:

Von 62 Patienten erhielten 49 eine Ganzhirnbestrahlung (WBRT), gefolgt von einem stereotaktischen Boost oder einer alleinigen stereotaktischen Radiochirurgie (SRS). 13 Patienten erhielten eine Resektion (OP), gefolgt von einer WBRT. Gesamtüberleben sowie intrazerebrale und lokale Kontrolle wurden retrospektiv analysiert. Alter, Geschlecht, Metastasenanzahl, extrazerebrale Metastasierung, RPA-Klassifizierung (rekursive Partitionsanalyse) und Zeitintervall zwischen Diagnosestellung und RT wurden als potentielle prognostische Faktoren untersucht.

Ergebnisse:

Medianes Gesamtüberleben und intrazerebrale Kontrolle betrugen 9 und 7 Monate. Ein signifikanter Unterschied zwischen RT und RT + OP hinsichtlich des Gesamtüberlebens (p = 0,696) und der intrazerebralen Kontrolle (p=0,996) konnte nicht festgestellt werden. In der multivariaten Analyse war ein verlängertes Gesamtüberleben mit fehlender extrazerebraler Metastasierung (p < 0,001) und der RPA-Klassenzugehörigkeit (p < 0,001) assoziiert. Die intrazerebrale Kontrolle (p < 0,001) war mit der RPA-Klassenzugehörigkeit (p < 0,001) assoziiert. Die lokalen 1-, 2- und 3-Jahres-Kontrollraten betrugen 78%, 66% und 51%; ein prognostischer Faktor dafür konnte nicht ermittelt werden.

Schlussfolgerung:

Es fanden sich keine signifikanten Unterschiede zwischen alleiniger RT (WBRT ± SRS) und OP + WBRT. Sah das therapeutische Konzept eine SRS vor, waren hervorragende Kontrollraten zu erzielen. RPA-Klassifizierung und das Fehlen von extrazerebralen Metastasen haben prognostische Auswirkung auf das Gesamtüberleben. Weitergehende Studien sollten eruieren, wer von einer aggressiveren Therapie profitiert.

Schlüsselwörter:

Gehirnmetastasen Radiochirurgie Harnblasenkarzinom Prognostische Faktoren 

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Copyright information

© Urban &amp; Vogel, Muenchen 2010

Authors and Affiliations

  • Emmanouil Fokas
    • 1
    • 2
  • Martin Henzel
    • 1
  • Rita Engenhart-Cabillic
    • 1
  1. 1.Department of Radiotherapy and Radiation OncologyPhilipps University MarburgMarburgGermany
  2. 2.Department of Radiotherapy and Radiation OncologyPhilipps University MarburgMarburgGermany

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