298. Toxicity and survival following radical radiotherapy in bladder cancer patients – a single institution experience

Bladder cancer is the second most common malignancy of the genitourinary tract. The efficacy of RT in more advanced disease or loco-regional recurrences is unsatisfactory. Surgery remains a mainstay of radical treatment, whereas radical radiotherapy alone or radiotherapy preceded by induction chemotherapy are optional organ-sparing methods. In our institution indications for external beam irradiation include positive surgical margins, T3 or N2. Here we present the analysis of treatment tolerance and patient survival in a consecutive series of patients who underwent postoperative radiotherapy for bladder cancer between 1992 and 2002.Patients and methodsHospital charts of 51 patients (3 women and 48 men, median age 64 years), were retrospecttively reviewed. T2, T3a, T3b and T4a stages were diagnosed in 14, 18, 7 and 11 cases respectively. Eleven patients underwent radical cystectomy (8 Brickertype and 3 other-type radical cystectomies), and in the remaining 40 patients transuretheral resection only was performed. In all cases surgical treatment was followed by conventionally fractionated megavoltage radiotherapy (two anteroposterior opposed fields) delivered to the whole pelvis to the total dose of 45–48 Gy, followed in 44 patients by a boost to the bladder to the total dose of 54–70 Gy (median 60 Gy; three- or four-field technique).ResultsAt a follow-up time of 4–119 months (median 22 months), 14 patients (27%) have been alive for a median of 47 months. Median actuarial survival for the whole group was 33.6 months. One patient was lost to follow-up. Acute toxic side-effects of treatment included grade 3 or 4 diarrhoea in 12 patients, dysuria in 14 patients, and both aforementioned side-effects in 5. Grade 3 acute side-effects occurred only in patients who received the total dose of at least 50 Gy. Median total dose in patients who experienced grade 3 bowel toxicity and bladder toxicity was 58.5 Gy and 60.3 Gy, respectively. At the total dose range of 50–59 Gy, 2 out of 14 patients experienced grade 3 dysuria, and 5 of 12 had bowel problems. Other (12 bladder, 7 bowel) toxicities were seen at the total dose of at least 60 Gy. 23 patients (45%) did not report any serious acute reactions.ConclusionRadiotherapy for bladder cancer is associated with manageable early toxicity, but its efficacy is still far from satisfactory