Acute toxicity of hypo- and conventionally-fractionated radiosensitised bladder radiotherapy

Abstract

Purpose or Objective Adding concurrent (chemo-)therapy to radiotherapy improves outcomes for muscle invasive bladder cancer patients. Recent meta-analysis demonstrates superior invasive locoregional disease control for a hypofractionated 55 gray (Gy) in 20 fractions (f) schedule compared to 64Gy in 32f. In the RAIDER clinical trial, patients undergoing 20f or 32f radical radiotherapy were randomised (1:1:2) to standard radiotherapy or to standard-dose or escalated-dose adaptive radiotherapy. Neoadjuvant chemotherapy and concomitant therapy were permitted in line with standard practice at each participant’s centre. We report acute toxicity by concomitant therapy-fractionation schedule combination. Materials and Methods Trial participants had unifocal bladder TCC staged T2-T4a N0 M0. Acute toxicity was assessed (CTCAE) weekly during radiotherapy and at 10 weeks after start of treatment. Within each fractionation cohort, a non-randomised comparison of the proportion of patients reporting grade 2 or worse (G2+) genitourinary (GU), gastrointestinal (GI) or other adverse events at any point in the acute period was performed using Fisher’s exact tests. Results Between October 2015 and April 2020, 345 (163 20f; 182 32f) patients were recruited from 46 centres. Median age was 73 years; 49% received neoadjuvant chemotherapy. 332 patients received study treatment of whom 244 (73%) received concomitant therapy (table 1). In those having concomitant therapy, acute G2+ toxicity was reported by 88/114 (77%) in 20f cohort and 102/130 (78%) in 32f cohort and is reported for the 3 most common regimens in table 2. The proportion of patients with G2+ GI toxicity differed by regimen (20f p=0.01; 32f p=0.005). The most common GI toxicities were diarrhoea (20f: 15.9%, 45.0%. 11.1%; 32f: 10.6%, 22.7%, 27.2% for the MMC/5FU, gemcitabine (G) and carbogen/nicotinamide (BCON) groups respectively) and anorexia (20f: 11.4%, 12.5%, 18.5%; 32f: 6.4%, 18.2%, 18.2% for MC/5FU, G, BCON respectively). G2+ acute adverse events are common with overall rates similar across concomitant therapy-fractionation schedules. The toxicity profile varied by type of concurrent treatment; for both fractionation schedules, GI toxicity rate appear higher in patients receiving gemcitabine.