ESTRO 2023

Session Item

Sunday

May 14

10:30 - 11:30

Plenary Hall

Genito-urinary

Chair: Daniel Matthias Aebersold, Switzerland;

Co-Chair: Johannes Knoth, Austria

Session Type: Proffered Papers

Track: Clinical

Journey:

10:30 - 10:40

Randomised phase II trial of adaptive image guided bladder radiotherapy: patient reported outcomes

Robert Huddart, United Kingdom

Presentation Number: OC-0431

Abstract

Abstract Title:

Randomised phase II trial of adaptive image guided bladder radiotherapy: patient reported outcomes

Authors:

Robert Huddart^1,2, Alison Birtle³, Ka Ching Cheung⁴, Ananya Choudhury⁵, Farshad Foroudi⁶, Hannah Gribble⁴, Clare Griffin⁴, Shaista Hafeez^1,7, Emma Hall⁴, Ann Henry⁸, Ben Hindson⁹, Rebecca Lewis⁴, Duncan McLaren¹⁰, Helen McNair^1,7, Ashok Nikapota¹¹, Abdullahi Omar⁴, Omi Parikh¹², Lara Philipps⁴, Isabel Syndikus¹³, Mohini Varughese¹⁴, Catalina Vassallo-Bonner¹⁵, Amanda Webster¹⁶

¹The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom; ²Royal Marsden Hospital NHS Foundation Trust, Radiotherapy Department, London, United Kingdom; ³Lancashire Teaching Hospitals NHS Foundation Trust, Cancer Oncology, Preston, United Kingdom; ⁴The Institute of Cancer Research, Clinical Trial and Statistics Unit, London, United Kingdom; ⁵The Christie NHS Foundation Trust, Translational Radiobiology, Manchester, United Kingdom; ⁶Austin Health, Radiation Oncology, Austin, Australia; ⁷The Royal Marsden NHS Foundation Trust, Radiotherapy Department, London, United Kingdom; ⁸Leeds Teaching Hospitals NHS Trust, Division of Cancer Studies and Pathology, Leeds, United Kingdom; ⁹Canterbury District Health Board, Department of Oncology Services, Christchurch, New Zealand; ¹⁰NHS Lothian, Department of Oncology, Edinburgh, United Kingdom; ¹¹Brighton and Sussex University Hospital NHS Trust, Clinical Oncology, Brighton, United Kingdom; ¹²Lancashire Teaching Hospitals NHS Trust, Oncology, Burnley, United Kingdom; ¹³The Clatterbridge Cancer Centre, Department of Radiotherapy, Liverpool, United Kingdom; ¹⁴Royal Devon & Exeter NHS Foundation Trust, Department of Oncology, Exeter, United Kingdom; ¹⁵The Institute of Cancer Research, Patient representative, London, United Kingdom; ¹⁶University College Hospital (UCLH), National Radiotherapy Trials Quality Assurance Group (RTTQA), London, United Kingdom

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Purpose or Objective

Radiotherapy (RT) to the bladder is challenging as it is a mobile, deformable structure. Plan of the day (POD) adaptive image-guided RT and tumour boost dose escalation can optimise treatment. We aimed to define a feasible, safe schedule for muscle-invasive bladder cancer (BC) using these techniques.

Material and Methods

RAIDER (ISRCTN 26779187) is an international phase II trial. Participants (pts) had unifocal T2-T4a urothelial BC and were randomised (1:1:2) to standard whole bladder RT (WBRT), standard dose adaptive tumour focused RT (SART) or dose-escalated adaptive tumour boost RT (DART). Two fractionation (f) schedules recruited independently. WBRT & SART dose was 64Gy/32f or 55Gy/20f and DART was 70Gy/32f or 60Gy/20f. For SART & DART, POD (small, medium, large) was chosen daily. Patient-reported outcomes (PRO) included the King’s Health Questionnaire (KHQ) and EQ5D-5L as key secondary endpoints and PRO-CTCAE collected before, during and after RT. Standard algorithms were used to derive scores: EQ5D general health score, KHQ bladder problem score, KHQ symptom severity scale In each fractionation cohort, data are presented by treatment received in pts who received at least 1f RT.

Results

345 pts were randomised: 46/41 WBRT, 46/41 SART and 90/81 DART pts in 32f/20f cohorts respectively. 170 (93%) 32f and 149(91%) 20f pts consented to the PRO substudy and started RT. Baseline characteristics for 32f/20f were median age 73 years (IQR 68-79)/72 (67-79); 84%/77% T2; 46%/56% had NAC and 71%/70% concomitant radiosensitising treatment. Median follow-up was 32f: 38 months (m) (IQR 26-50), 20f: 42m (36-50). For 98% of SART/DART pts >1 RT plan was used with 3588/6222 (58%) fractions using adaptation (small or large plan). PRO reported at last RT fraction and at 12m are shown (table) with KHQ bladder problem ratings and PRO-CTCAE stool frequency at 12m (figure).

Conclusion

Pts generally reported similar side effect profiles across treatment groups and fractionation cohorts. DART was well tolerated with no evidence of increased toxicity.