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Prevention of local symptoms in muscle invasive bladder cancer patients: clinical significance of local radiation therapy

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Abstract

Purpose

To evaluate the significance of local radiation therapy (LRT) for prevention of local symptoms (LSs) caused by muscle-invasive bladder cancer (MIBC).

Methods

We retrospectively reviewed the clinical records of 133 patients from 13 hospitals. MIBC patients with or without metastases who were treated with LRT alone from January 2015 through December 2020 were enrolled. Exclusion criteria were urinary diversion (UD) prior to LRT, non-MIBC, or lack of clinical information. LSs were defined as hematuria requiring invasive treatment or transfusion, UD after LRT, bladder tamponade, and opioid use for bladder pain.

Results

One hundred fourteen patients were finally enrolled in the study. During the median follow-up period of 13.5 months, 30 patients (26.3%) had LSs. Risk factors of LSs in multivariate analysis were a prior history of non-MIBC (NMIBC) (hazard ratio [HR] 2.99; 95% confidence interval [CI], 1.36 to 6.56; P < 0.01), radiation dose of less than 50 Gray (Gy) (HR 3.99; 95% CI, 1.80 to 8.82; P < 0.01), and tumor stage 3 or more (HR 2.43; 95% CI, 1.14 to 5.21; P = 0.02). Risk factors of overall survival (OS) in multivariate analysis were being female (HR 3.32; 95% CI, 1.68 to 6.58; P < 0.01), an age-adjusted Charlson Comorbidity index of 6 or more (HR 2.19; 95% CI, 1.18 to 4.10; P = 0.01), distant metastases (HR 3.20; 95% CI, 1.39 to 6.58; P < 0.01), and tumor size of 40 mm or more (HR 2.38; 95% CI, 1.34 to 4.52; P < 0.01). Toxicity (all grades) occurred in 40.4% of the patients, 4.8% with grade 3 or more and 95.2% with lower grades.

Conclusions

We determined the risk factors for LSs in MIBC patients treated with LRT alone. An escalated-dose of 50 Gy or more may contribute to prevention of LSs caused by MIBC. Thus, dose-escalated LRT for MIBC patients who can expect favorable survival may be a good option to avoid future annoying LSs.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan

    Manabu Okada

  2. Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan

    Tetsuya Shindo, Keiko Fujino, Kohei Hashimoto, Ko Kobayashi, Toshiaki Tanaka & Naoya Masumori

  3. Department of Urology, Oji General Hospital, Tomakomai, Japan

    Toshihiro Maeda

  4. Department of Urology, NTT East Medical Center Sapporo, Sapporo, Japan

    Naoki Ito

  5. Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan

    Atsushi Takahashi

  6. Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan

    Hiroshi Hotta

  7. Department of Urology, Sunagawa City Medical Center, Sunagawa, Japan

    Yasuharu Kunishima

  8. Department of Urology, Takikawa Municipal Hospital, Takikawa, Japan

    Masanori Matsukawa

  9. Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan

    Akio Takayanagi

  10. Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan

    Atsushi Wanifuchi

  11. Department of Urology, Hokkaido Medical Center, Sapporo, Japan

    Seisuke Nofuji

  12. Department of Urology, Muroran City General Hospital, Muroran, Japan

    Ryuichi Kato

  13. Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan

    Fumimasa Fukuta

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  1. Manabu Okada
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  2. Tetsuya Shindo
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Contributions

Conception and design: Manabu Okada, Tetsuya Shindo, Atsushi Takahashi,Kohei Hashimoto, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori.

Data collection: Manabu Okada, Tetsuya Shindo, Toshihiro Maeda, Naoki Ito, Atsushi Takahashi, Hiroshi Hotta, Yasuharu Kunishima, Masanori Matsukawa, Akio Takayanagi, Atsushi Wanifuchi, Seisuke Nofuji, Ryuichi Kato, Fumimasa Fukuta.

Data analysis and interpretation: Manabu Okada, Tetsuya Shindo, Keiko Fujino, Kohei Hashimoto, Ko Kobayashi, Toshiaki Tanaka, Naoya Masumori.

Manuscript writing: Manabu Okada, Tetsuya Shindo, Kohei Hashimoto, Naoya Masumori.

Final approval of manuscript: All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tetsuya Shindo.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki and approval was obtained from the Sapporo Medical University School of Medicine Ethics Committee (332–300).

Consent to participate

An opt-out consent process was used because of the retrospective nature of the study.

Conflict of interest

The authors declare no competing interests.

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Okada, M., Shindo, T., Fujino, K. et al. Prevention of local symptoms in muscle invasive bladder cancer patients: clinical significance of local radiation therapy. Support Care Cancer 31, 607 (2023). https://doi.org/10.1007/s00520-023-08087-6

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