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A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer

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A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer A. Choudhury*, R. Swindell*, J. P. Logue*, P. A. Elliott*, J.E. Livsey*, P. Symonds # , J. P. Wylie*, N.W. Clarke*, A. E. Kiltie $ , R.A. Cowan* *The Christie, Wimslow Road, Manchester M20 4BX, # Leicester Royal Infirmary, Leicester LE1 5WW, $ The Gray Institute, Oxford OX3 7DQ J Clin Oncol. 2011 Feb 20;29(6):733-8. Epub 2011 Jan 4.
Outline ,[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object]
Comparison of RT and surgery: Disease-specific survival Kotwal et al: Int. J. Radiation Oncology Biol. Phys., Vol. 70, No. 2, pp. 456–463, 2008
Prognostic factors ,[object Object],[object Object],[object Object],[object Object],[object Object]
Patient selection for radical radiotherapy treatment ,[object Object],[object Object],[object Object],[object Object]
Conventional whole bladder RT-The Christie 1 ,[object Object],[object Object],[object Object],[object Object],(1) Cowan et al. Int. J. Radiation Oncology Biol. Phys., Vol. 59, No. 1, pp. 197–207, 2004
Christie series Cowan. R, McBain. C. et al. Int. J. Radiation Oncology Biol. Phys., Vol. 59, pp. 197-207, 2004 5yr Survival OS: 58% DSS: 65%
Chemoradiation ,[object Object],[object Object],[object Object]
Results of Canadian Trial Pelvic-recurrence free survival Overall survival Coppin et al: Journal of Clinical Oncology, Vol 14, No 11 (November), 1996: pp 2901-2907
Summary of bladder preservation studies to 2010 Rene et al. Curr Oncol > v.16(4); Aug 2009
Rationale for GemX ,[object Object],[object Object],[object Object],[object Object]
Christie phase I GemX study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sangar et al: Int J Radiat Oncol Biol Phys. 2005 Feb 1;61(2):420-5.
Phase II methods ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Choudhury et al. J Clin Oncol. 2011 Feb 20;29(6):733-8. Epub 2011 Jan 4.
Centres Manchester 31 Leeds 10 Preston 2 Leicester 7
Preliminary results compared to conventional Age Median 67yrs (48-84yrs) Median 67yrs (40-82yrs) Gender M: 39 F: 11 M: 44 F: 16 WHO PS 0: 25 1: 19 2: 1 Not known: 5 ≤ 1: 53 >1: 7 Histology TCC: 47 Mixed: 3 TCC: 55 Grade II: 3 III: 47 II: 8 III: 51 CIS 12 T stage T2: 40 T3: 8 T2: 17 T3: 42 Hydronephrosis 5 18
Treatment ,[object Object],[object Object],[object Object]
Check cystoscopy ,[object Object],[object Object],GemX Standard RT CR 44 88% 45 75% Superficial 3 6% 7 12% Muscle-invasive 0 3 4% Not done 3 6% 5 8%
Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cystectomy post GemX ,[object Object],[object Object],[object Object],[object Object]
Survival ,[object Object],[object Object],[object Object]
Overall survival ,[object Object],[object Object]
Disease-specific survival ,[object Object],[object Object]
Patient-reported late toxicity
Bladder preservation 2011 ,[object Object],[object Object]
Cause-specific survival of patients with primary v secondary cystectomy Addla et al. The Journal of Urology Vol. 181, Issue 4, Supplement, Page 633
Where do we go from here? ,[object Object],[object Object],[object Object],[object Object]

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A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer

  • 1. A multicentre phase II study of hypofractionated conformal radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer A. Choudhury*, R. Swindell*, J. P. Logue*, P. A. Elliott*, J.E. Livsey*, P. Symonds # , J. P. Wylie*, N.W. Clarke*, A. E. Kiltie $ , R.A. Cowan* *The Christie, Wimslow Road, Manchester M20 4BX, # Leicester Royal Infirmary, Leicester LE1 5WW, $ The Gray Institute, Oxford OX3 7DQ J Clin Oncol. 2011 Feb 20;29(6):733-8. Epub 2011 Jan 4.
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  • 4. Comparison of RT and surgery: Disease-specific survival Kotwal et al: Int. J. Radiation Oncology Biol. Phys., Vol. 70, No. 2, pp. 456–463, 2008
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  • 8. Christie series Cowan. R, McBain. C. et al. Int. J. Radiation Oncology Biol. Phys., Vol. 59, pp. 197-207, 2004 5yr Survival OS: 58% DSS: 65%
  • 9.
  • 10. Results of Canadian Trial Pelvic-recurrence free survival Overall survival Coppin et al: Journal of Clinical Oncology, Vol 14, No 11 (November), 1996: pp 2901-2907
  • 11. Summary of bladder preservation studies to 2010 Rene et al. Curr Oncol > v.16(4); Aug 2009
  • 12.
  • 13.
  • 14.
  • 15. Centres Manchester 31 Leeds 10 Preston 2 Leicester 7
  • 16. Preliminary results compared to conventional Age Median 67yrs (48-84yrs) Median 67yrs (40-82yrs) Gender M: 39 F: 11 M: 44 F: 16 WHO PS 0: 25 1: 19 2: 1 Not known: 5 ≤ 1: 53 >1: 7 Histology TCC: 47 Mixed: 3 TCC: 55 Grade II: 3 III: 47 II: 8 III: 51 CIS 12 T stage T2: 40 T3: 8 T2: 17 T3: 42 Hydronephrosis 5 18
  • 17.
  • 18.
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  • 25.
  • 26. Cause-specific survival of patients with primary v secondary cystectomy Addla et al. The Journal of Urology Vol. 181, Issue 4, Supplement, Page 633
  • 27.