Genitourinary Cancer

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SU_20_2200 - Bladder-sparing Hypofractionated Intensity Modulated Radiation Therapy plus Weekly Gemcitabine in Patients with Invasive Bladder Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Bladder-sparing Hypofractionated Intensity Modulated Radiation Therapy plus Weekly Gemcitabine in Patients with Invasive Bladder Cancer
S. M. Alrashidi1, L. Souhami1, F. Cury1, M. Vanhuyse1, A. Aprikian1, M. Duclos1, R. Rajan1, S. Tanguay1, S. L. Faria1, and W. Kassouf2; 1McGill University Health Centre, Montreal, QC, Canada, 2McGill University, Montreal, QC, Canada

Purpose/Objective(s): Trimodality therapy (TMT) is an effective and appealing alternative for bladder preservation in selected patients with muscle invasive bladder cancer (MIBC). Cisplatin has been frequently used as a radiosensitizer. However, in this usually elderly population with compromised renal function, the use of cisplatin may not be always feasible. We report results of hypofractionated IMRT (HypoIMRT) and weekly gemcitabine as components of a TMT regimen for patients with MIBC.

Materials/Methods: From June 2008 to June 2017, 49 patients with T2-3N0M0 bladder cancer underwent treatment with HypoIMRT with concomitant weekly gemcitabine following maximal transurethral resection of bladder tumor (TURBT). HypoIMRT delivered a dose of 50 Gy in 20 fractions to the whole empty bladder and 40 Gy to pelvic nodes in the same 20 fractions. Weekly gemcitabine at a dose of 100 mg/m2 was given concomitantly. Patients treated with neoadjuvant chemotherapy or those treated with another chemotherapy agent were not included. Response rate was assessed by cystoscopy evaluation and bladder biopsy.

Results: The median age was 76 years (range: 58-91). A complete TURBT was achieved in 90% of patients. A complete response post-therapy was confirmed in 88% of the patients. At a median follow-up of 20 months, 20 patients had died, 10 of them from bladder cancer. Of those patients achieving a complete response, 29 patients (67.5%) have remained disease-free at a median follow-up of 21 months. The median time for either local or distant failure was 12 months. 8 patients (16%) failed in the bladder only (5 with superficial and 3 with invasive disease) with an actuarial local control projection of 75% at 3 years. Of the 8 patients failing locally, 3 of them presented with hydronephrosis and 2 had an incomplete TURBT; 13 patients (26.5%) failed distantly. The 3- and 5-year cancer-specific survival rate was 77%. Treatments were well tolerated with all patients completing HypoIMRT and 78% completing 4 cycles of gemcitabine. Grade 3 acute GU or GI toxicity was seen in 2% of patients (no grade 4 or 5). Late grade 2 or higher GI or GU toxicity was seen in 2% and 6%, respectively (no grade 4 or 5).

Conclusion: HypoIMRT plus concurrent weekly gemcitabine post-TURBT is an effective, feasible and well-tolerated curative treatment strategy in selected patients with MIBC.

Author Disclosure: S.M. Alrashidi: None. L. Souhami: Honoraria; Varian Medical System. Advisory Board; Jansenn, Bayer. Member GU Core Committee; NRG Oncology. F. Cury: None. M. Vanhuyse: None. A. Aprikian: Advisory Board; Bayer. M. Duclos: Advisory Board; Bayer. R. Rajan: None. S. Tanguay: None. W. Kassouf: Research Grant; Roche. Vice President (communications); Wassim Kassouf.

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