U.L.P.
Top Line: Ever wonder what it would be like if Cary Fukunaga designed an RTOG trial?
The Study: Right on the heels of Maniac comes RTOG 0712. Let’s start with the easy part. 70 patients with muscle invasive bladder cancer who could tolerate surgery and chemo were enrolled after undergoing maximal TURBT. They were then randomized to two bladder preservation arms—which, interesting side note, weren’t designed to be compared. Keep reading. In the “FCT” arm fluorouracil and cisplatin were administered with radiation, while in the “GD” arm gemcitabine was given. Simple, right? Wrong. The radiation regimen in FCT was the good ole RTOG twice-daily regimen, which gave 1.6 Gy each morning to the pelvis and 1.5 Gy each afternoon to the bladder → tumor cone-down. The GD “Michigan” regimen gave 2 Gy once daily to the shrinking volumes of pelvis → bladder → tumor. To be fair, the RTOG may have actually been attempting a brilliant ploy to confuse the cancer into submission. A clinical response upon cystoscopy at a scheduled break after ~40 Gy was achieved in 88% of the FCT arm and 78% of the GD arm, who all went on to complete chemoradiation followed by adjuvant gem/cis. The primary endpoint of freedom from distant failure at 3 years was 78% for FCT and 84% for GD, both exceeding the prespecified 75% threshold. In the end, grade 3-4 toxicity was seen in 64% and 55% of patients, respectively, and frowns were seen in 100% of dosimetrists and therapists.
Bottom Line: You're not wrong if you continue to stick with simple daily chemoradiation for bladder preservation. | Coen, J Clin Oncol 2018
The Study: Right on the heels of Maniac comes RTOG 0712. Let’s start with the easy part. 70 patients with muscle invasive bladder cancer who could tolerate surgery and chemo were enrolled after undergoing maximal TURBT. They were then randomized to two bladder preservation arms—which, interesting side note, weren’t designed to be compared. Keep reading. In the “FCT” arm fluorouracil and cisplatin were administered with radiation, while in the “GD” arm gemcitabine was given. Simple, right? Wrong. The radiation regimen in FCT was the good ole RTOG twice-daily regimen, which gave 1.6 Gy each morning to the pelvis and 1.5 Gy each afternoon to the bladder → tumor cone-down. The GD “Michigan” regimen gave 2 Gy once daily to the shrinking volumes of pelvis → bladder → tumor. To be fair, the RTOG may have actually been attempting a brilliant ploy to confuse the cancer into submission. A clinical response upon cystoscopy at a scheduled break after ~40 Gy was achieved in 88% of the FCT arm and 78% of the GD arm, who all went on to complete chemoradiation followed by adjuvant gem/cis. The primary endpoint of freedom from distant failure at 3 years was 78% for FCT and 84% for GD, both exceeding the prespecified 75% threshold. In the end, grade 3-4 toxicity was seen in 64% and 55% of patients, respectively, and frowns were seen in 100% of dosimetrists and therapists.
Bottom Line: You're not wrong if you continue to stick with simple daily chemoradiation for bladder preservation. | Coen, J Clin Oncol 2018
Most random and best reference thus far!
ReplyDeletei want to say a very big thanks to Dr Aluya for helping me return my boyfriend home with his powerful spell i never believe my boyfriend will come back to me after Eight months of breaking up with me i decided to go online to search for a powerful spell caster i met a lot of testimony online about Dr Aluya so i decided to give him a try and i contacted him for help and he give me his words not to worry about anything once He is done with his work after 48hrs my boyfriend is going to be back,after 48hrs i receive a phone call when i pick it i hard my boyfriend voice and he started pleading with me to forgive him which i did for more info you can contact his Email aluya.48hoursspelltemple@gmail.com you can also add him up on whatsapp +2348110493039 may God continue to bless your hand work.
ReplyDelete