PALLIATIVE RADIOTHERAPY FOR BLADDER CANCER: A SMALL RETROSPECTIVE STUDY

• Published in: Anticancer research 2010-04, Vol.30 (4), p.1515-1515
• Main Authors: Spagnoletti, G, De Nobili, G, Marchese, R, Leo, A M, Rignanese, R, Bove, G
• Format: Article
• Language: English
• ISSN: 0250-7005

Background: Curative treatment of bladder cancer is based on radical cystectomy or transurethral resection followed by radiotherapy and concomitant chemotherapy. Unfortunately, tumours are usually found at advanced stages, or the general condition of the patient is reduced and aggressive therapy is therefore contraindicated. In these situations, palliative treatment is of extraordinary importance. In this retrospective study, we analysed the utility of palliative radiotherapy in advanced bladder cancer and evaluated the results of the different fractionation regimens. Patients and Methods: From October 2006 to December 2009, 25 patients (pts) with grade III urothelial carcinoma of the bladder (T2-4N0-2) received palliative external radiotherapy. All patients (21 males and 4 females) presented with haematuria and local pain and their medical conditions or disease status prevented an operation or a radical multimodal therapy. The mean age was 77 (range: 63-87) years. Many different fractionation schedules were used: conventional irradiation with 20-30 fractions up to 40-54 Gy in 16 cases and hypofractionated radiotherapy with 1-3 fractions of 6-10 Gy once a week in 9 cases. Treatments were carried out with three or four 10-18 MV photon beams. Results: Half of all patients (12 pts) achieved complete remission of the initial symptoms and one fourth (6 pts) showed a partial remission. On the whole, three out of four patients experienced symptomatic relief. Haematuria improved in 76.5% of affected patients (13/17 pts). Pain and/or dysuria decreased in 41.7% of complaining patients (5/12 pts). The mean duration of response was 17 weeks (range 3-118). A comparison between hypofractionated and conventional regimens suggested a more important and rapid improvement in symptoms control with the shorter courses. The rates of complete clearing of haematuria were 22.2% (2/9 pts) in the conventional fractionated group and 50% (4/8 pts) in the hypofractionated group. Among the short schedules we used, 6 Gy fractions were found to be the least useful treatment: up to 3 fractions, we observed only a slight benefit. We did not notice any significant difference in the toxicity of the two schedules. Acute genitourinary toxicity was observed in 48% of patients (12 pts) but no significant late toxicity was noted. The overall survival rates were 24% at one year (6 pts) and 12% at two years (3 pts). Nine patients are still living with persistent tumours and one of them has reached