Tolerance of orthotopic ileal neobladders to radiotherapy: A multi-institutional retrospective study

• Published in: Clinical genitourinary cancer 2017-12, Vol.15 (6), p.711-716
• Main Authors: Ballas, Leslie, MD, Sargos, Paul, MD, Orré, Mathieu, MD, Bian, Shelly X., MD, Daneshmand, Siamak, MD, Eapen, Libni J., MD
• Format: Article
• Language: English
• Subjects: Adjuvant; Aged; Bladder cancer; Cystectomy; Dose Fractionation; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Radiation; Radiotherapy, Adjuvant - adverse effects; Retrospective Studies; Treatment Outcome; Urinary Bladder Neoplasms - radiotherapy; Urinary Bladder Neoplasms - surgery; Urinary Reservoirs, Continent; Urology; Urothelial cell carcinoma
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2017.05.007

Abstract Purpose This retrospective study analyzes tolerance of orthotopic ileal neobladders to radiotherapy by reviewing the acute and late toxicity in patients who underwent post-operative radiotherapy following radical cystectomy/cystoprostatectomy (RC). Materials/Methods A multi-institutional database was created for patients who underwent RC and neobladder reconstruction followed by adjuvant radiotherapy (RT). Patient and tumor characteristics were recorded. RT data was reviewed to determine the treatment technique used, the dose of radiation received by the neobladder as well as acute and late toxicity evaluated by the CTCAE V4.0 scale. Results 25 patients were included with a median age of 64 years old. 18/25 patients received a dose of 45Gy-50.4Gy. The most common reasons for post-operative radiotherapy were close or positive surgical margins and pT3-4 or N+ disease. Ten patients were treated with IMRT. All but one patient completed radiation. Of the patients that completed their radiation schedule, none had Grade 3 or higher acute GI toxicity; one patient who received concurrent chemotherapy had Grade 3 acute GU toxicity. Three patients reported late grade 1 GU toxicity (frequency of urination, mild leakage at night), with no reports of chronic GI toxicity. None of the patients experienced neobladder perforation, leak, or fistula. Conclusions The use of moderate doses of pelvic radiotherapy (45-50.4Gy) was well tolerated among the 25 patients who had radiotherapy following cystoprostatectomy with orthotopic neobladder creation. This data supports the use of post-operative radiotherapy to moderate doses in this patient population when clinically indicated.