Complete radiological response of hepatic metastases from bladder cancer following whole-liver low-dose radiotherapy with simultaneous integrated boost combined with chemoimmunotherapy: a case report
Abstract
BackgroundUrothelial carcinoma with neuroendocrine differentiation is a rare, yet highly aggressive histological subtype of bladder cancer, characterized by rapid disease progression, poor prognosis, and a tendency to metastasize, with the liver being a common metastatic site. Current treatments involving chemotherapy and immunotherapy have limitations, including poor patient tolerability and the rapid development of drug resistance, particularly in patients exhibiting low PD-L1 expression and those who have failed multiple lines of therapy. Increasing evidence supports the use of low-dose radiotherapy (LDRT) as an immunomodulatory approach that can overcome drug resistance in many patients.Case presentationHerein, we report the case of a 54-year-old male patient with urothelial carcinoma exhibiting partial neuroendocrine differentiation and extensive liver metastases. PD-L1 testing revealed a combined positive score of 1. The patient had developed resistance following first-line chemotherapy and second-line chemoimmunotherapy. As a third-line treatment, he received whole-liver LDRT (WL-LDRT: 5 Gy in 10 fractions), with a simultaneous integrated boost to selected lesions, combined with immunotherapy and chemotherapy. One month post-treatment, imaging demonstrated that the patient had shown a partial response to treatment, athree months later, all the liver metastases were disappeared. Notably, the patient achieved progression-free survival exceeding 9 months.ConclusionTo the best of our knowledge, this is the first case report of a patient with extensive liver metastases from bladder cancer who achieved complete radiological response of the hepatic metastases after overcoming resistance to both chemotherapy and immunotherapy with a combination of WL-LDRT and simultaneous integrated boost. This case highlights a novel and potentially safe salvage strategy for treating similar cases of chemotherapy- and immunotherapy-refractory metastatic bladder cancer, which could help improve the clinical outcomes of patients with this rare but highly aggressive cancer.
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BibTeX
@article{han2026complete,
title = {{Complete radiological response of hepatic metastases from bladder cancer following whole-liver low-dose radiotherapy with simultaneous integrated boost combined with chemoimmunotherapy: a case report}},
author = {Changmin Han and Xiongjie Yu and Liguo Gao and Fengjun Cao},
journal = {Frontiers in Oncology},
year = {2026},
month = nov,
doi = {10.3389/fonc.2026.1965942},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1965942},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Complete radiological response of hepatic metastases from bladder cancer following whole-liver low-dose radiotherapy with simultaneous integrated boost combined with chemoimmunotherapy: a case report
AU - Changmin Han
AU - Xiongjie Yu
AU - Liguo Gao
AU - Fengjun Cao
PY - 2026
DA - 2026/11/12
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1965942
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1965942
AB - BackgroundUrothelial carcinoma with neuroendocrine differentiation is a rare, yet highly aggressive histological subtype of bladder cancer, characterized by rapid disease progression, poor prognosis, and a tendency to metastasize, with the liver being a common metastatic site. Current treatments involving chemotherapy and immunotherapy have limitations, including poor patient tolerability and the rapid development of drug resistance, particularly in patients exhibiting low PD-L1 expression and those who have failed multiple lines of therapy. Increasing evidence supports the use of low-dose radiotherapy (LDRT) as an immunomodulatory approach that can overcome drug resistance in many patients.Case presentationHerein, we report the case of a 54-year-old male patient with urothelial carcinoma exhibiting partial neuroendocrine differentiation and extensive liver metastases. PD-L1 testing revealed a combined positive score of 1. The patient had developed resistance following first-line chemotherapy and second-line chemoimmunotherapy. As a third-line treatment, he received whole-liver LDRT (WL-LDRT: 5 Gy in 10 fractions), with a simultaneous integrated boost to selected lesions, combined with immunotherapy and chemotherapy. One month post-treatment, imaging demonstrated that the patient had shown a partial response to treatment, athree months later, all the liver metastases were disappeared. Notably, the patient achieved progression-free survival exceeding 9 months.ConclusionTo the best of our knowledge, this is the first case report of a patient with extensive liver metastases from bladder cancer who achieved complete radiological response of the hepatic metastases after overcoming resistance to both chemotherapy and immunotherapy with a combination of WL-LDRT and simultaneous integrated boost. This case highlights a novel and potentially safe salvage strategy for treating similar cases of chemotherapy- and immunotherapy-refractory metastatic bladder cancer, which could help improve the clinical outcomes of patients with this rare but highly aggressive cancer.
SN - 2234-943X
ER -