Hemostatic radiotherapy in advanced bladder cancer: a single-institution experience

Abstract

Objective

While external beam radiotherapy (RT) is a widely used modality to attempt to arrest bleeding in advanced bladder cancer, the evidentiary base to support its use is relatively modest. The aims of this analysis were to determine the likelihood and duration of hemostasis following palliative external beam RT for primary bladder carcinoma with uncontrolled bleeding and to identify clinical and pathologic factors that influence duration of hemostasis.

Methods

A retrospective review was undertaken of the records of patients with invasive carcinoma of the bladder cancer treated at a comprehensive cancer center from 2002 to 2013. Patients were eligible if they presented with uncontrolled gross hematuria and were treated with palliative-intent RT where one of the stated goals of RT was hemostasis. The primary outcome was the initial hemostatic response to RT while secondary outcomes included freedom from recurrent bleeding (FFRB) and overall survival (OS). Multivariate Cox regression modeling was used to identify clinical, pathologic, and treatment-related factors associated with prolonged FFRB.

Results

Sixty-seven patients were eligible, of which 34 patients (51%) had stage IV disease. A complete hemostatic response to RT was observed in 49 patients (73%), while a partial hemostatic response was observed in 11 patients (16%), and no response was observed in 7 patients (10%). Median FFRB in complete responders was 4.4 months while median OS following RT was 8.7 months. On multivariate analysis, only the biologically effective dose (BED) of radiotherapy was significantly associated with prolonged FFRB while female gender was significantly associated with foreshortened FFRB.

Conclusion

Palliative bladder RT conferred an initial complete hemostatic response in a majority of patients. While in absolute terms the duration of hemostasis was relatively modest, on average bleeding was controlled following RT for the majority of the remaining life expectancy in this population with advanced bladder malignancy and a poor prognosis. Prospective trials assessing the value of hemostatic RT are encouraged.

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