Muscle-invasive bladder cancer treated with external beam radiotherapy: Prognostic factors
Alan Pollack, Gunar K. Zagars, David A. Swanson
Purpose: To determine the relationship of several potential prognostic factors to the outcome measures of pelvic control, freedom from metastases, and overall survival for bladder cancer patients treated with definitive external beam radiotherapy. Methods and materials: The records of 135 patients treated with high-dose, planned continuous-course, external beam radiotherapy for muscle-invasive transitional cell bladder cancer were reviewed. These patients were treated to an average total dose of 6588 ± 475 cGy with an average fractional dose of 207 ± 18 cGy using megavoltage. Median potential follow-up for all patients, including those who died, was 249 months. Results: The actuarial results at 5 year were 31% pelvic control, 58% freedom from metastases, and 26% overall survival. In the univariate analyses, several factors were correlated with disease outcome including clinical stage, tumor morphology, gross total transurethral resection (TURBT), findings at bimanual exam after TURBT, clinical perivesical extension, age, and clinical complete response at first follow-up cystoscopy (Clinical-CR). A Cox proportional hazards model revealed that only Clinical-CR was independently predictive of pelvic control. In terms of freedom from metastases, only Clinical-CR and clinical stage were significantly associated with outcome in the multivariate analysis. When the multivariate analysis was restricted to T2 and T3 tumors only, then clinical perivesical extension replaced stage as being associated with freedom from metastases. The only factors significantly related to overall survival in the Cox proportional hazards model were Clinical-CR, age, and complete TURBT: stage was of borderline significance when only pretreatment factors were considered. Conclusions: Clearly, the most important prognostic factor was Clinical-CR. The pretreatment factors of stage, clinical perivesical extension, and gross total TURBT also correlated with outcome, but, to a lesser degree. For patients medically unfit for radical cystectomy radiotherapy is a viable option, particularly for selected patients. Patients with T4 tumors are poor candidates for definitive radiotherapy and should be treated palliatively if they cannot tolerate systemic therapy.
International Journal of Radiation Oncology, Biology, Physics
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bladder Physics & Astronomy
muscles Physics & Astronomy
radiation therapy Physics & Astronomy
Urinary Bladder Neoplasms Medicine & Life Sciences
cancer Physics & Astronomy
metastasis Physics & Astronomy
Radiotherapy Medicine & Life Sciences
Muscles Medicine & Life Sciences
Pollack, A., Zagars, G. K., & Swanson, D. A. (1994). Muscle-invasive bladder cancer treated with external beam radiotherapy: Prognostic factors. International Journal of Radiation Oncology, Biology, Physics, 30(2), 267-277. https://doi.org/10.1016/0360-3016(94)90004-3
Muscle-invasive bladder cancer treated with external beam radiotherapy : Prognostic factors. / Pollack, Alan; Zagars, Gunar K.; Swanson, David A.
In: International Journal of Radiation Oncology, Biology, Physics, Vol. 30, No. 2, 30.09.1994, p. 267-277.
Pollack, A, Zagars, GK & Swanson, DA 1994, 'Muscle-invasive bladder cancer treated with external beam radiotherapy: Prognostic factors', International Journal of Radiation Oncology, Biology, Physics, vol. 30, no. 2, pp. 267-277. https://doi.org/10.1016/0360-3016(94)90004-3
Pollack A, Zagars GK, Swanson DA. Muscle-invasive bladder cancer treated with external beam radiotherapy: Prognostic factors. International Journal of Radiation Oncology, Biology, Physics. 1994 Sep 30;30(2):267-277. https://doi.org/10.1016/0360-3016(94)90004-3
Pollack, Alan ; Zagars, Gunar K. ; Swanson, David A. / Muscle-invasive bladder cancer treated with external beam radiotherapy : Prognostic factors. In: International Journal of Radiation Oncology, Biology, Physics. 1994 ; Vol. 30, No. 2. pp. 267-277.
@article{4c18ad9883c5489a8ae7aca7267936e3,
title = "Muscle-invasive bladder cancer treated with external beam radiotherapy: Prognostic factors",
abstract = "Purpose: To determine the relationship of several potential prognostic factors to the outcome measures of pelvic control, freedom from metastases, and overall survival for bladder cancer patients treated with definitive external beam radiotherapy. Methods and materials: The records of 135 patients treated with high-dose, planned continuous-course, external beam radiotherapy for muscle-invasive transitional cell bladder cancer were reviewed. These patients were treated to an average total dose of 6588 ± 475 cGy with an average fractional dose of 207 ± 18 cGy using megavoltage. Median potential follow-up for all patients, including those who died, was 249 months. Results: The actuarial results at 5 year were 31% pelvic control, 58% freedom from metastases, and 26% overall survival. In the univariate analyses, several factors were correlated with disease outcome including clinical stage, tumor morphology, gross total transurethral resection (TURBT), findings at bimanual exam after TURBT, clinical perivesical extension, age, and clinical complete response at first follow-up cystoscopy (Clinical-CR). A Cox proportional hazards model revealed that only Clinical-CR was independently predictive of pelvic control. In terms of freedom from metastases, only Clinical-CR and clinical stage were significantly associated with outcome in the multivariate analysis. When the multivariate analysis was restricted to T2 and T3 tumors only, then clinical perivesical extension replaced stage as being associated with freedom from metastases. The only factors significantly related to overall survival in the Cox proportional hazards model were Clinical-CR, age, and complete TURBT: stage was of borderline significance when only pretreatment factors were considered. Conclusions: Clearly, the most important prognostic factor was Clinical-CR. The pretreatment factors of stage, clinical perivesical extension, and gross total TURBT also correlated with outcome, but, to a lesser degree. For patients medically unfit for radical cystectomy radiotherapy is a viable option, particularly for selected patients. Patients with T4 tumors are poor candidates for definitive radiotherapy and should be treated palliatively if they cannot tolerate systemic therapy.",
keywords = "Bladder cancer, Prognostic factors, Radiation therapy",
author = "Alan Pollack and Zagars, {Gunar K.} and Swanson, {David A.}",
journal = "International Journal of Radiation Oncology Biology Physics",
T1 - Muscle-invasive bladder cancer treated with external beam radiotherapy
T2 - Prognostic factors
AU - Pollack, Alan
AU - Zagars, Gunar K.
AU - Swanson, David A.
N2 - Purpose: To determine the relationship of several potential prognostic factors to the outcome measures of pelvic control, freedom from metastases, and overall survival for bladder cancer patients treated with definitive external beam radiotherapy. Methods and materials: The records of 135 patients treated with high-dose, planned continuous-course, external beam radiotherapy for muscle-invasive transitional cell bladder cancer were reviewed. These patients were treated to an average total dose of 6588 ± 475 cGy with an average fractional dose of 207 ± 18 cGy using megavoltage. Median potential follow-up for all patients, including those who died, was 249 months. Results: The actuarial results at 5 year were 31% pelvic control, 58% freedom from metastases, and 26% overall survival. In the univariate analyses, several factors were correlated with disease outcome including clinical stage, tumor morphology, gross total transurethral resection (TURBT), findings at bimanual exam after TURBT, clinical perivesical extension, age, and clinical complete response at first follow-up cystoscopy (Clinical-CR). A Cox proportional hazards model revealed that only Clinical-CR was independently predictive of pelvic control. In terms of freedom from metastases, only Clinical-CR and clinical stage were significantly associated with outcome in the multivariate analysis. When the multivariate analysis was restricted to T2 and T3 tumors only, then clinical perivesical extension replaced stage as being associated with freedom from metastases. The only factors significantly related to overall survival in the Cox proportional hazards model were Clinical-CR, age, and complete TURBT: stage was of borderline significance when only pretreatment factors were considered. Conclusions: Clearly, the most important prognostic factor was Clinical-CR. The pretreatment factors of stage, clinical perivesical extension, and gross total TURBT also correlated with outcome, but, to a lesser degree. For patients medically unfit for radical cystectomy radiotherapy is a viable option, particularly for selected patients. Patients with T4 tumors are poor candidates for definitive radiotherapy and should be treated palliatively if they cannot tolerate systemic therapy.
AB - Purpose: To determine the relationship of several potential prognostic factors to the outcome measures of pelvic control, freedom from metastases, and overall survival for bladder cancer patients treated with definitive external beam radiotherapy. Methods and materials: The records of 135 patients treated with high-dose, planned continuous-course, external beam radiotherapy for muscle-invasive transitional cell bladder cancer were reviewed. These patients were treated to an average total dose of 6588 ± 475 cGy with an average fractional dose of 207 ± 18 cGy using megavoltage. Median potential follow-up for all patients, including those who died, was 249 months. Results: The actuarial results at 5 year were 31% pelvic control, 58% freedom from metastases, and 26% overall survival. In the univariate analyses, several factors were correlated with disease outcome including clinical stage, tumor morphology, gross total transurethral resection (TURBT), findings at bimanual exam after TURBT, clinical perivesical extension, age, and clinical complete response at first follow-up cystoscopy (Clinical-CR). A Cox proportional hazards model revealed that only Clinical-CR was independently predictive of pelvic control. In terms of freedom from metastases, only Clinical-CR and clinical stage were significantly associated with outcome in the multivariate analysis. When the multivariate analysis was restricted to T2 and T3 tumors only, then clinical perivesical extension replaced stage as being associated with freedom from metastases. The only factors significantly related to overall survival in the Cox proportional hazards model were Clinical-CR, age, and complete TURBT: stage was of borderline significance when only pretreatment factors were considered. Conclusions: Clearly, the most important prognostic factor was Clinical-CR. The pretreatment factors of stage, clinical perivesical extension, and gross total TURBT also correlated with outcome, but, to a lesser degree. For patients medically unfit for radical cystectomy radiotherapy is a viable option, particularly for selected patients. Patients with T4 tumors are poor candidates for definitive radiotherapy and should be treated palliatively if they cannot tolerate systemic therapy.
KW - Bladder cancer
KW - Prognostic factors
KW - Radiation therapy
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics