Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, presented “Updates in Chemoradiation for Bladder Urothelial Cancer” at the 27th Annual Innovations in Urologic Practice conference on September 22nd, 2023.
How to cite: Hamstra, Daniel A. “Updates in Chemoradiation for Bladder Urothelial Cancer.” September 2023. Accessed Oct 2024. https://grandroundsinurology.com/updates-in-chemoradiation-for-bladder-urothelial-cancer/
Updates in Chemoradiation for Bladder Urothelial Cancer – Summary
Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, discusses updates in chemoradiation for bladder urothelial cancer. He compares data from a retrospective review on cystectomy vs. trimodality therapy for muscle-invasive bladder cancer, explaining that the data showed no difference in metastasis-free survival and minimal difference in overall survival.
Dr. Hamstra shares data from a study on local therapy in clinical node-positive bladder cancer that showed no difference in OS or progression-free survival with surgery vs. radiation therapy. He then explains that surgical management is critical for bladder preservation therapy.
Dr. Hamstra explains the North American trimodality therapy patient selection process and explains that, while it excludes poor responders to treatment (therefore ensuring a higher likelihood of bladder preservation,) it also excludes many patients. He outlines the UK approach to therapy, calling it a broader-based treatment.
Dr. Hamstra then summarizes data on chemoradiation for MIBC that show locoregional control was substantially better, and metastasis-free survival was somewhat better, when chemotherapy was combined with radiation therapy vs. radiation therapy alone. He then addresses whether concurrent chemoradiation therapy is needed following neoadjuvant chemotherapy, explaining while it has potentially smaller impact on the other endpoints, chemoradiation therapy still increased locoregional control and invasive locoregional control.
Dr. Hamstra addresses radiation therapy, its role and the best approach to radiation therapy delivery. Dr. Hamstra shares data out of Pakistan comparing bladder-only radiation therapy vs. pelvis and bladder radiation therapy that shows no improvement when treating the pelvic lymph nodes.
Dr. Hamstra concludes that trimodality bladder preservation represents a viable but under-utilized option for bladder cancer. It is a viable option in non-operative candidates or node-positive disease, and there are multiple chemotherapy options. He points out the importance of coordinated care and newer agents that may be used with radiation therapy to improve outcomes.
About The 27th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma; men’s health topics like male infertility, andrology, and sexual dysfunction; OAB and voiding dysfunctions; and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Daniel A. Hamstra, MD, PhD, is Professor and Chair of Radiation Oncology at Baylor College of Medicine in Houston, Texas. Dr. Hamstra specializes in prostate cancer and tumors of the brain and spine with a particular focus on understanding patients’ experience both during and after treatment. His work has made a substantial impact on the growing understanding and appreciation of patient reported quality of life after radiation therapy. He has led local and national clinical trials of radiation therapy in prostate cancer and is an active member of several medical professional societies including the American Society of Clinical Oncology, the American Society of Therapeutic Radiation Oncology, and SWOG.
