High dose-rate intra-operative radiation therapy during high risk genitourinary surgery: Initial observations and a proposal for its study in bladder cancer

Max Kates, Meera R. Chappidi, Aaron Brant, Niv Milbar, Nikolai A. Sopko, Christian Meyer, Stephanie A Terezakis, Joseph M. Herman, Jonathan Efron, Bashar Safar, Phuoc T Tran, Nita Ahuja, Phillip Martin Pierorazio, Trinity Bivalacqua

Research output: Contribution to journalArticle

Abstract

Background: High dose-rate Intra-Operative Radiation Therapy (HD-IORT) is used to provide effective local control for patients with high-risk locally advanced or recurrent tumors. However, the utility of HD-IORT for patients with bladder cancer has not been studied. Objective: To characterize our institutional experience with HD-IORT in patients with cancer requiring genitourinary surgery, in an effort to identify patients with bladder cancer that may benefit from HD-IORT. Methods: We performed a retrospective review of all patients who have undergone HD-IORT during genitourinary surgery at our institution. Patients were stratified by surgical margin status, and primary outcomes assessed were overall survival, recurrence free survival and 90-day complications. Patients undergoing cystectomy and HD-IORT with sarcomatoid urothelial cancer were compared to a similar cohort undergoing cystectomy alone. A sample case of one such patient is discussed in detail. Results: 84 patients at our institution have undergone HD-IORT with genitourinary surgery. Positive surgical margin status was the greatest predictor of both OS (HR=3.42) and RFS (HR=2.61). The overall 90-day complication rate was 61, with wound infections (43) and GI complications (21) being most common. 4 of these patients had sarcomatoid urothelial histology, and all are still alive with >2yrs follow up. This compares to a 52 1 yr survival in our sarcomatoid urothelial cohort (25 pts) that did not undergo HD-IORT. Conclusions: Our institutional experience with HD-IORT has been promising, particularly among patients with locally advanced disease and sarcomatoid histology. We are currently enrolling patients in a multi-institutional registry to assess the utility of HD-IORT in high risk bladder cancer.

Original languageEnglish (US)
Pages (from-to)191-199
Number of pages9
JournalBladder Cancer
Volume3
Issue number3
DOIs
StatePublished - Jan 1 2017

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Urinary Bladder Neoplasms
Radiotherapy
Cystectomy
Survival
Histology
Urogenital Neoplasms
Wound Infection
Registries
Neoplasms
Recurrence

Keywords

  • Bladder cancer
  • radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

High dose-rate intra-operative radiation therapy during high risk genitourinary surgery : Initial observations and a proposal for its study in bladder cancer. / Kates, Max; Chappidi, Meera R.; Brant, Aaron; Milbar, Niv; Sopko, Nikolai A.; Meyer, Christian; Terezakis, Stephanie A; Herman, Joseph M.; Efron, Jonathan; Safar, Bashar; Tran, Phuoc T; Ahuja, Nita; Pierorazio, Phillip Martin; Bivalacqua, Trinity.

In: Bladder Cancer, Vol. 3, No. 3, 01.01.2017, p. 191-199.

Research output: Contribution to journalArticle

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abstract = "Background: High dose-rate Intra-Operative Radiation Therapy (HD-IORT) is used to provide effective local control for patients with high-risk locally advanced or recurrent tumors. However, the utility of HD-IORT for patients with bladder cancer has not been studied. Objective: To characterize our institutional experience with HD-IORT in patients with cancer requiring genitourinary surgery, in an effort to identify patients with bladder cancer that may benefit from HD-IORT. Methods: We performed a retrospective review of all patients who have undergone HD-IORT during genitourinary surgery at our institution. Patients were stratified by surgical margin status, and primary outcomes assessed were overall survival, recurrence free survival and 90-day complications. Patients undergoing cystectomy and HD-IORT with sarcomatoid urothelial cancer were compared to a similar cohort undergoing cystectomy alone. A sample case of one such patient is discussed in detail. Results: 84 patients at our institution have undergone HD-IORT with genitourinary surgery. Positive surgical margin status was the greatest predictor of both OS (HR=3.42) and RFS (HR=2.61). The overall 90-day complication rate was 61, with wound infections (43) and GI complications (21) being most common. 4 of these patients had sarcomatoid urothelial histology, and all are still alive with >2yrs follow up. This compares to a 52 1 yr survival in our sarcomatoid urothelial cohort (25 pts) that did not undergo HD-IORT. Conclusions: Our institutional experience with HD-IORT has been promising, particularly among patients with locally advanced disease and sarcomatoid histology. We are currently enrolling patients in a multi-institutional registry to assess the utility of HD-IORT in high risk bladder cancer.",
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AU - Milbar, Niv

AU - Sopko, Nikolai A.

AU - Meyer, Christian

AU - Terezakis, Stephanie A

AU - Herman, Joseph M.

AU - Efron, Jonathan

AU - Safar, Bashar

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