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      Carbon ion radiotherapy for bladder cancer: A case report

      case-report

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          Abstract

          BACKGROUND

          Radical cystectomy is considered the first choice for the treatment of muscle-invasive bladder cancer. However, for some patients who have lost the indications for surgery, external beam radiotherapy is a non-invasive and effective treatment.

          CASE SUMMARY

          A 76-year-old patient with bladder cancer who had serious comorbidities and could not tolerate surgery or chemotherapy came to the Wuwei Heavy Ion Center. He received carbon ion radiotherapy (CIRT) with a whole-bladder dose of 44 GyE and tumor boost of 20 GyE. When he finished CIRT, his bladder cancer-related hematuria completely disappeared, and computed tomography examination showed that the tumor had obviously decreased in size. At the 3-mo follow-up, the tumor disappeared, and there were no acute or late adverse events. CIRT was well tolerated in this patient.

          CONCLUSION

          CIRT may allow for avoiding resection and was well tolerated with curative outcomes.

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          Most cited references20

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          Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic

          Girish S Kulkarni, Thomas Hermanns, Yanliang Wei … (2017)
          Purpose Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. Methods Data from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinoma in situ status, and hydronephrosis) with propensity scores to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox proportional hazards modeling and a competing risk analysis, respectively. Results A total of 112 patients with MIBC were included after matching (56 who had been treated with TMT, and 56 who underwent RC). The median age was 68.0 years, and 29.5% had stage cT3/cT4 disease. At a median follow-up of 4.51 years, there were 20 deaths (35.7%) in the RC group (13 as a result of BC) and 22 deaths (39.3%) in the TMT group (13 as a result of BC). The 5-year DSS rate was 73.2% and 76.6% in the RC and TMT groups, respectively ( P = .49). Salvage cystectomy was performed in 6 (10.7%) of 56 patients who received TMT. Conclusion In the setting of a MDBCC, TMT yielded survival outcomes similar to those of matched patients who underwent RC. Appropriately selected patients with MIBC should be offered the opportunity to discuss various treatment options, including organ-sparing TMT.
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            Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review.

            Guillaume Ploussard, Siamak Daneshmand, Jason Efstathiou … (2014)
            Aims of bladder preservation in muscle-invasive bladder cancer (MIBC) are to offer a quality-of-life advantage and avoid potential morbidity or mortality of radical cystectomy (RC) without compromising oncologic outcomes. Because of the lack of a completed randomised controlled trial, oncologic equivalence of bladder preservation modality treatments compared with RC remains unknown. This systematic review sought to assess the modern bladder-preservation treatment modalities, focusing on trimodal therapy (TMT) in MIBC. A systematic literature search in the PubMed and Cochrane databases was performed from 1980 to July 2013. Optimal bladder-preservation treatment includes a safe transurethral resection of the bladder tumour as complete as possible followed by radiation therapy (RT) with concurrent radiosensitising chemotherapy. A standard radiation schedule includes external-beam RT to the bladder and limited pelvic lymph nodes to an initial dose of 40 Gy, with a boost to the whole bladder to 54 Gy and a further tumour boost to a total dose of 64-65 Gy. Radiosensitising chemotherapy with phase 3 trial evidence in support exists for cisplatin and mitomycin C plus 5-fluorouracil. A cystoscopic assessment with systematic rebiopsy should be performed at TMT completion or early after TMT induction. Thus, nonresponders are identified early to promptly offer salvage RC. The 5-yr cancer-specific survival and overall survival rates range from 50% to 82% and from 36% to 74%, respectively, with salvage cystectomy rates of 25-30%. There are no definitive data to support the benefit of using of neoadjuvant or adjuvant chemotherapy. Critical to good outcomes is proper patient selection. The best cancers eligible for bladder preservation are those with low-volume T2 disease without hydronephrosis or extensive carcinoma in situ. A growing body of accumulated data suggests that bladder preservation with TMT leads to acceptable outcomes and therefore may be considered a reasonable treatment option in well-selected patients. Treatment based on a combination of resection, chemotherapy, and radiotherapy as bladder-sparing strategies may be considered as a reasonable treatment option in properly selected patients. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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              Risk of subsequent primary cancers after carbon ion radiotherapy, photon radiotherapy, or surgery for localised prostate cancer: a propensity score-weighted, retrospective, cohort study

              Osama Mohamad, Takahiro Tabuchi, Yuki Nitta … (2019)
              Article 0 comments Cited 38 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yan-Shan Zhang
                Xiao-Jun Li
                Yi-He Zhang
                Ting-Chao Hu
                Wei-Zuo Chen
                Xin Pan
                Hong-Yu Chai
                Xin Wang
                Yu-Ling Yang
                Journal
                Journal ID (nlm-ta): World J Clin Cases
                Journal ID (publisher-id): WJCC
                Title: World Journal of Clinical Cases
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2307-8960
                Publication date (Print): 16 September 2021
                Publication date (Electronic): 16 September 2021
                Volume: 9
                Issue: 26
                Pages: 7833-7839
                Affiliations
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China. 13830510999@ 123456163.com
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Heavy Ion Center, Wuwei Cancer Hospital, Wuwei 733000, Gansu Province, China
                Author notes

                Author contributions: Zhang YS and Li XJ equally contributed to this article and should be regarded as co-first authors; Zhang YS, Li XJ, Zhang YH, and Hu TC designed the study; Chen WZ, Pan X, and Chai HY drafted the work; Wang X and Yang YL collected the data; Zhang YS and Li XJ analyzed and interpreted the data; Zhang YH and Hu TC wrote the article.

                Supported by Key R&D Plan of Science and Technology Program of Gansu Province, China, No. 19YF3FH001.

                Corresponding author: Yan-Shan Zhang, PhD, Chief Doctor, Heavy Ion Center, Wuwei Cancer Hospital, No. 31 Sanitary Lane, Haizang Road, Wuwei 733000, Gansu Province, China. 13830510999@ 123456163.com

                Article
                Other ID: jWJCC.v9.i26.pg7833
                DOI: 10.12998/wjcc.v9.i26.7833
                PMC ID: 8462265
                SO-VID: 48b8fe7a-d25c-4c60-8b2a-6b38f964b445
                Copyright © ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/

                History
                Date received : 6 April 2021
                Date revision received : 9 May 2021
                Date accepted : 6 July 2021
                Categories
                Subject: Case Report

                Keywords: carbon ion radiotherapy,bladder cancer,galloping scheme,case report
                Data availability:
                Keywords: carbon ion radiotherapy, bladder cancer, galloping scheme, case report

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