Evaluation of efficacy and toxicity in two different hypofractionated 3D-conformal external beam radiotherapy schedules in localised muscle invasive bladder cancer

• Published in: Journal of B.U. ON. Vol. 18; no. 4; p. 942
• Main Authors: Kouloulias, V, Mosa, E, Tolia, M, Kantzou, I, Koliarakis, N, Platoni, K, Georgakopoulos, I, Siatelis, A, Sarris, G, Beli, I, Chrisofos, M, Kelekis, N
• Format: Journal Article
• Language: English
• Published: Greece 01-10-2013
• Subjects: Age Factors; Aged; Aged, 80 and over; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - radiotherapy; Carcinoma, Transitional Cell - secondary; Chi-Square Distribution; Disease-Free Survival; Dose Fractionation; Female; Gastrointestinal Diseases - diagnosis; Gastrointestinal Diseases - etiology; Humans; Kaplan-Meier Estimate; Male; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Prospective Studies; Radiation Injuries - diagnosis; Radiation Injuries - etiology; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - mortality; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - radiotherapy
• ISSN: 1107-0625

To evaluate the efficacy as well as acute and late toxicity of two different accelerated hypofractionated 3D-conformal radiotherapy (Hypo-3DCRT) schedules in patients with bladder cancer.
Between February 2006 and June 2011, 50 elderly patients with cT1-2N0 bladder carcinoma were treated with Hypo-3DCRT. Mean age was 75 years. All patients were medically inoperable, with poor performance status, who couldn't tolerate either cystectomy or radical external beam irradiation on a daily basis. A dose of 36 Gy in 6 weekly fractions (arm A, N=39) or 39.96 Gy of 3.33 Gy twice daily, once a week, for 6 weeks (arm B, N=11) were prescribed. The primary study endpoints were the evaluation of acute/late gastrointestinal (GI) toxicity according to the EORTC/RTOG scale together with the visual analogue bladder-related pain score (VAS).
The GI acute toxicities were: grade 1: arm A 24/39 (61.5%), arm B 9/11 (81.8%); grade 2: arm A 14/39 (35.9%), arm B 1/11 (9.1%); grade 3: arm A 1/39 (9.1%) (x(2), p=0.29). Only grade 1 late GI toxicity was seen and was significantly higher in arm A: arm A 17/39 (43.6%) and arm B 1/11 (9.1%) (x(2), p=0.037). The reduction of VAS score was similar in both arms (p=0.065). The median relapse free survival (RFS) was 15 and 16 months for arm A and B, respectively (log rank, p=0.71).
Beyond the non-randomized design of the trial, the Hypo-3DCRT schedules used appear to be an acceptable alternative to the traditional longer radiotherapy (RT) schedules for elderly patients unfit for daily irradiation.