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Evaluating the Current Place of Radiotherapy as Treatment Option for Patients With Muscle Invasive Bladder Cancer in Belgium

Published:August 10, 2018DOI:https://doi.org/10.1016/j.clgc.2018.07.026

      Abstract

      Introduction

      There is a gap between optimal and actual use of radiotherapy (RT) in muscle-invasive bladder cancer (MIBC). We investigated the opinions of radiation-oncologists, urologists, and medical oncologists on use of RT in different cases. Barriers and facilitators for applying guidelines were examined.

      Material and Methods

      A web-based survey was developed at Ghent University Hospital and conducted from November 18, 2016 to July 17, 2017. The place of primary, adjuvant, and palliative RT was evaluated. Additional questions assessed the use of guidelines, barriers, and facilitators.

      Results

      In total, 126 physicians (57 radiation oncologists, 41 urologists, and 28 medical oncologists) completed the survey. Significant differences in use of RT in the primary and adjuvant setting were observed between radiation oncologists and urologists. Younger age and presence of hydronephrosis are perceived as contraindications for RT in the primary setting. In the adjuvant setting, RT was mainly considered in case of positive surgical margins. All radiation oncologists and 96% of medical oncologists considered palliative RT for patients with painful bone metastases, whereas 21% of urologists did not (P < .001). Clinical decisions are mainly based on EAU guidelines. The most important reason for nonadherence to guidelines is external barriers (18%). One strategy to improve awareness of guidelines is a summary of guidelines on the website of national organizations (54%).

      Conclusion

      There is controversy regarding the place of RT in MIBC, with a clear variation between professionals. Barriers and facilitators to use RT should be addressed, seeing the gap in RT utilization and predicted increase in patients requiring RT for MIBC.

      Keywords

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      References

        • Leow J.
        • William M.
        • Rajagopal P.
        • et al.
        Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials.
        Eur Urol. 2014; 66: 42-54
        • Borras J.M.
        • Barton M.
        • Grau C.
        • et al.
        The impact of cancer incidence and stage on optimal utilization of radiotherapy: methodology of a population based analysis by the ESTRO-HERO project.
        Radiot Oncol. 2015; 116: 45-50
        • Borras J.M.
        • Lievens Y.
        • Barton M.
        • et al.
        How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis.
        Radiot Oncol. 2016; 119: 5-11
        • Lievens Y.
        • De Schutter H.
        • Stellamans K.
        • Rosskamp M.
        • Van Eycken L.
        • on behalf of the Belgian College for Physicians in Radiation Oncology
        Radiotherapy access in Belgium: how far are we from evidence-based utilisation.
        EJC. 2017; 84: 102-113
        • Borras J.M.
        • Lievens Y.
        • Dunscombe P.
        • et al.
        The optimal utilization proportion of external beam radiotherapy in European countries: an ESTRO-HERO analysis.
        Radiot Oncol. 2015; 116: 38-44
        • Haines A.
        • Kuruvilla S.
        • Borchert M.
        Bridging the implementation gap between knowledge and action for health.
        Bull World Health Organ. 2004; 82: 724-731
        • Witjes J.A.
        • Lebret T.
        • Compérat E.M.
        • et al.
        Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer.
        Eur Urol. 2017; 71: 462-475
        • Spiess P.E.
        • Aqarwal N.
        • Bangs R.
        • et al.
        Bladder cancer, version 5.2107, NCCN clinical practice guidelines in oncology.
        J Natl Compr Can Netw. 2017; 15: 1240-1267
        • Bellmunt J.
        • Orsola A.
        • Leow J.J.
        • et al.
        Bladder cancer: ESMO practice guidelines for diagnosis, treatment and follow up.
        Ann Oncol. 2014; 25: 40-48
        • Chang S.S.
        • Bochner B.H.
        • Chou
        • et al.
        Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline.
        J Urol. 2017; 198: 552-559
        • Bazargani S.T.
        • Djaladat H.
        • Ahmadi H.
        • et al.
        Gastro-intestinal complications following radical cystectomy using enhanced recovery protocol.
        Eur Urol Focus. 2017; https://doi.org/10.1016/j.euf.2017.04.003
        • Lauridsen S.V.
        • Tonnesen H.
        • Jensen B.T.
        • Neuner B.
        • Thind P.
        • Thomsen T.
        Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs.
        Syst Rev. 2017; 6: 150
        • Huddart R.A.
        • Birtle A.
        • Maynard L.
        • et al.
        Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of the selective bladder preservation versus radical cystectomy.
        BJU. 2017; 120: 639-650
        • Kulkarni G.S.
        • Hermanns T.
        • Wei Y.
        • et al.
        Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic.
        J Clin Oncol. 2017; 35: 2299-2305
        • Efsthathiou J.A.
        • Spiegel D.Y.
        • Shipley W.U.
        • et al.
        Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience.
        Eur Urol. 2012; 61: 705-711
        • James N.D.
        • Hussain S.A.
        • Hall E.
        • et al.
        Radiotherapy with or without chemotherapy in muscle invasive bladder cancer.
        N Engl J Med. 2012; 366: 1477-1488
        • Caffo O.
        • Thompson C.
        • De Santis M.
        • et al.
        Concurrent gemcitabine and radiotherapy for the treatment of muscle-inviasve bladder cancer: a pooled individual data analysis of eight phase I-II trials.
        Radiot Oncol. 2016; 121: 193-198
        • Chung P.W.
        • Bristow R.G.
        • Milosevic M.F.
        • et al.
        Long-term outcome of radiation-based conservation therapy for invasive bladder cancer.
        Urol Oncol. 2007; 25: 303e9
        • Ploussard G.
        • Daneshmand S.
        • Efstathiou J.A.
        • et al.
        Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review.
        Eur Urol. 2017; 66: 120-137
        • Fonteyne V.
        • Ost P.
        • Bellmunt J.
        • et al.
        Curative treatment for muscle invasive bladder cancer in elderly patients: a systematic review.
        Eur Urol. 2018; 73: 40-50
        • Bream M.J.
        • Maurice M.J.
        • Altschuler J.
        • Zhu H.
        • Abouassaly R.
        Increased use of cystectomy in patients 75 and older: a contemporary analysis of survival and peri-operative outcomes from the national cancer database.
        Urology. 2017; 100: 72-78
        • Fisher-Valuck B.W.
        • Rao Y.J.
        • Rudra S.
        • et al.
        Treatment patterns and overall survival outcomes of octogenarians with muscle invasive cancer of the bladder: an analysis of the national cancer database.
        J Urol. 2018; 199: 416-423
        • Chiang Y.
        • Cheng J.C.
        • Huang C.Y.
        • et al.
        A role of multimodality bladder-preserving therapy in patients with muscle-invasive bladder cancer plus hydronephrosis with or without pelvic nodal involvement.
        J Formos Med Assoc. 2017; 116: 689-696
        • Grossman H.B.
        • Natale R.B.
        • Tangen C.M.
        • et al.
        Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer.
        N Engl J Med. 2003; 349: 859-866
        • Baumann B.C.
        • Guzzo T.
        • He J.
        • et al.
        Bladder cancer patterns of pelvic failure: implications for adjuvant radiation therapy.
        Int J Radiat Oncol Biol Phys. 2013; 85: 363-369
        • Herr H.W.
        • Faulkner J.R.
        • Grossman H.B.
        • et al.
        Surgical factors influence bladder cancer outcomes: a cooperative group report.
        J Clin Oncol. 2004; 22: 2781-2789
        • Christodouleas J.P.
        • Baumann B.C.
        • He J.
        • et al.
        Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710.
        Cancer. 2014; 120: 1272-1280
        • Pollack A.
        • Zagars G.K.
        • Dinney C.P.
        • et al.
        Preoperative radiotherapy for muscle-invasive bladder carcinoma. Long term follow up and prognostic factors for 338 patients.
        Cancer. 1994; 74: 2819-2827
        • Zaghloul M.S.
        • Christodouleas J.P.
        • Smith A.
        • et al.
        Adjuvant chemotherapy plus radiotherapy vs adjuvant chemotherapy alone for locally advanced bladder cancer after radical cystectomy: a randomized phase 2 trial.
        JAMA Surg. 2018; 153: e174591
        • Zaghloul M.S.
        • Awwad H.K.
        • Omar S.
        • et al.
        Postoperative radiotherapy of carcinoma in bilharzial bladder. Improved disease-free survival through improving local control.
        Int J Radiat Oncol Biol Phys. 1992; 22: 511-517
        • Wang-Chesebro A.
        • Xia P.
        • Coleman J.
        • et al.
        Intensity-modulated radiotherapy improves lymph node coverage and dose to critical structures compared with three-dimensional conformal radiation therapy in clinically localized prostate cancer.
        Int J Radiat Oncol Biol Phys. 2006; 66: 654-662
        • Fonteyne V.
        • Lumen N.
        • Ost P.
        • et al.
        Hypofractionated intensity-modulated arc therapy for lymph node metastasized prostate cancer: toxicity and 3-years clinical outcome.
        Radiother Oncol. 2013; 109: 229-234
        • Vandecasteele K.
        • De Neve W.
        • De Gersem W.
        • et al.
        Intensity-modulated arc therapy with simultaneous integrated boost in the treatment of primary irresectable cervical cancer. Treatment planning, quality control, and clinical implementation.
        Strahlenther Onkol. 2009; 185: 799-807
        • Bauman B.C.
        • Sargos P.
        • Eapen L.J.
        • et al.
        The rationale for post-operative radiation in localized bladder cancer.
        Bladder Cancer. 2017; 3: 19-30
        • Reddy A.V.
        • Pariser J.J.
        • Pearce S.M.
        • et al.
        Patterns of failure after radical cystectomy for pT3-4 bladder cancer: implications for adjuvant radiation therapy.
        Int J Radiat Oncol Biol Phys. 2016; 94: 1031-1039
        • Ballas L.
        • Sargos P.
        • Orré M.
        • Bian S.X.
        • Daneshmand S.
        • Eapen L.J.
        Tolerance of orthotopic ileal neobladders to radiotherapy: a multi-institutional retrospective study.
        Clin Genitourin Cancer. 2017; 15: 711-716
        • Wu J.S.
        • Wong R.K.
        • Lloyd N.S.
        • Johnston M.
        • Bezjak A.
        • Whelan T.
        Supportive Care Guidelines Group of Cancer Care Ontario. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases - an evidence-based practice guideline.
        BMC Cancer. 2004; 4: 71
        • Ploeg M.
        • Kums A.C.
        • Aben K.K.
        • et al.
        Prognostic factors for survival in patients with recurrence of muscle invasive bladder cancer after treatment with curative intent.
        Clin Genitourin Cancer. 2011; 9: 14-21
        • Cabana M.D.
        • Rand C.S.
        • Powe N.R.
        • et al.
        Why don't physicians follow clinical practice guidelines? A framework for improvement.
        JAMA. 1999; 282: 1458-1465
        • Pathman D.E.
        • Konrad T.R.
        • Freed G.L.
        • Freeman V.A.
        • Koch G.G.
        The awareness-to-adherence model of the steps to clinical guideline compliance: the case of pediatric vaccine recommendations.
        Med Care. 1996; 34: 873-889
        • Farell M.J.
        • Yahya J.B.
        • Degnin C.
        • et al.
        Timing of thoracic radiation therapy with chemotherapy in limited-stage small cell lung cancer: survey of US radiation oncologists on current practice patterns.
        Clin Lung Cancer. 2018; https://doi.org/10.1016/j.clic.2018.04.007
        • Yoo H.J.
        • Hong J.J.
        • Bok Ko Y.
        • et al.
        Current Practice of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal surface maligniancies: an international survey of oncologic surgeons.
        World J Surg Oncol. 2018; 16: 92
        • Melnychuck M.
        • Vindrola-Padros C.
        • Aitchison M.
        • et al.
        Centralising specialists cancer surgery services in England: survey of factors that matter to patients and carers of health professionals.
        BMC Cancer. 2018; 18: 226
        • Walker M.
        • Doiron R.C.
        • French S.
        • et al.
        Peri-operative chemotherapy for bladder cancer: a survey of providers to determine barriers and enablers.
        Bladder Cancer. 2018; 4: 49-65