Review of hypo-fractionated radiotherapy for localized muscle invasive bladder cancer

• Published in: Critical reviews in oncology/hematology 2019-10, Vol.142, p.76-85
• Main Authors: Amestoy, Frédéric, Roubaud, Guilhem, Antoine, Mikaël, Fonteyne, Valérie, Baumann, Brian C., Christodouleas, John, Roupret, Morgan, Azria, David, Zilli, Thomas, Hennequin, Christophe, Xylinas, Evanguelos, Sargos, Paul
• Format: Article
• Language: English
• Subjects: Bladder neoplasm; Chemo-radiation; Hypofractionated; Life Sciences; Radiotherapy
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2019.06.010

•- For selected patients, trimodal therapy is considered as an alternative.•Hypo-fractionated radiotherapy, allows good 2-year recurrence free survival rate and 5-year Overall Survival rates with acceptable late toxicities.•This strategy must be evaluated with the use of modern radiotherapy techniques such as adaptive radiotherapy in prospective controlled trials including quality of life scales. •The most common treatment for non-metastatic muscle invasive bladder cancer (MIBC) is radical cystectomy with pelvic lymph node dissection. For selected patients, trimodal therapy (TMT) consisting in a maximal transurethral resection of the bladder, followed by a concurrent chemotherapy and radiotherapy, spread over 5 to 7 weeks, is considered as an acceptable option. We aimed to perform a systematic review to report the current results of curative hypo-fractionated radiotherapy in terms of oncological outcomes and toxicity. In total, 5 phase III and 13 phase II trials were retained. Our review shows that TMT using hypo-fractionated radiotherapy allows a 2-year recurrence free survival rate between 43% and 83%, a 5-year OS rate going from 36% to 58%. Less than 12% of late grade ≥3 gastro-intestinal toxicities and between 4 to 46% grade ≥3 genito-urinary late toxicities were observed. This approach must be evaluated with prospective trials including quality of life scales.