title: Is hyperthermia combined with radiotherapy adequate in elderly patients with muscle-invasive bladder cancers? Thermo-radiobiological implications from an audit of initial results.
abstract: The aim of this study was to evaluate the outcomes of loco-regional hyperthermia (HT) with radiotherapy (RT) and/or chemotherapy (CT) in elderly patients with muscle-invasive bladder cancers (MIBC).
  
  
  
  Twenty consecutive MIBC patients were treated with HTRT (n = 8) or HTCTRT (n = 12) following transurethral resection of their bladder tumours. Weekly HT was administered prior to RT to a mean temperature of 40.6-42.7 °C for 60 min. A mean RT dose of 54.6 Gy (SD ± 4.2) was delivered. Single-agent cisplatin (n = 2) or carboplatin (n = 10) was used in HTCTRT patients.
  
  
  
  The median age was 81 years. HTRT patients received a mean RT dose of 51.0 Gy compared to 57.1 Gy with HTCTRT (p < 0.001) in a shorter overall treatment time (OTT) (30.8 ± 6.9 versus 43.9 ± 4.0 days, p < 0.001). All HTRT patients had long-term local disease control, while 41.6% of HTCTRT recurred during follow-up. None of the HTRT patients experienced grade III/IV acute and late toxicities, while these were evident in two and one HTCTRT patients respectively. Taken together, the 3-year bladder preservation, local disease-free survival, cause-specific survival and overall survival were 86.6%, 60.7%, 55% and 39.5% respectively. Even though the mean biological effective dose (BED) for both groups was similar (57.8 Gy15), the thermo-radiobiological BED estimated from HT-induced reduction of α/β was significantly higher for HTRT patients (91 ± 4.4 versus 85.8 ± 4.3 Gy3, p = 0.018).
  
  
  
  Thermal radiosensitisation with consequent reduction in α/β results in a higher thermo-radiobiological BED with a relatively higher RT dose/fraction and shorter OTT. This translates into a favourable outcome in elderly MIBC patients. Any benefit of CT in these patients needs further investigation.
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .
authors.forename: Niloy R
authors.initials: NR
authors.lastname: Datta
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .
authors.forename: Brigitte
authors.initials: B
authors.lastname: Eberle
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .
authors.forename: Emsad
authors.initials: E
authors.lastname: Puric
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .
authors.forename: Andreas
authors.initials: A
authors.lastname: Meister
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .
authors.forename: Dietmar
authors.initials: D
authors.lastname: Marder
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .
authors.forename: Olaf
authors.initials: O
authors.lastname: Tim
authors.affiliation: a Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Aarau , Switzerland .|b Faculty of Surgery , Saint Petersburg State University , Saint Petersburg , Russia .
authors.forename: Anton
authors.initials: A
authors.lastname: Klimov
authors.affiliation: c Centre for Radiation Oncology , KSA-KSB , Kantonsspital Aarau , Switzerland , and.|d Department of Radiation Oncology , University Hospital Zurich , Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Bodis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary / Q000628:therapy*; D011829:Radiation Dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin; D002945:Cisplatin
keywords: Chemotherapy; hyperthermia; muscle-invasive bladder cancers; radiotherapy; thermal radiobiology