Radiotherapy of T4 bladder carcinoma

A comparison of two radiotherapy regimens for the treatment of symptoms from advanced bladder cancer

Pain and haematuria are two of the most distressing symptoms in patients with advanced bladder cancer. The aim of palliative radiotherapy is to relieve these symptoms with the minimum of stress to the patient and with minimal side effects. Two treatment regimens were studied: hypofractionated radiotherapy giving 1700 cGy in two fractions over 3 days and conventional palliative radiotherapy giving 4500 cGy in 12 fractions over 26 days. This study assesses 41 patients, all with Grade II-III T3-4 transitional cell carcinomas of the bladder treated between 1982 and 1989, presenting with haematuria and local pain. Two-fraction (hypofractionated) treatment was given to 22 patients and conventional palliative radiotherapy to 19; patients were selected by performance status. The effect on haematuria was assessed as cleared, intermittent or persistent. Pain was assessed by noting reduction in the need for opiate analgesia. Any side effect was recorded. In the patients receiving two-fraction radiotherapy, 59% had clearance of the haematuria and in 73% there was improvement of their pain, compared with 16% and 37% respectively in those receiving conventional palliation. Survival of the two groups was 9.77 months and 14.47 months respectively. Side effects were trivial in both regimens. Radiotherapy given in two fractions for patients in poor general health is well tolerated and less distressing than the standard palliative regimen with 12 fractions. Haematuria and pain were more effectively palliated than with conventional treatment, though survival was shorter. We conclude that hypofractionated radiotherapy may be the palliative treatment of choice and the study supports the need for a prospective assessment of this treatment approach.

Radical external beam radiotherapy of urinary bladder carcinoma. An analysis of results in 500 patients

Between 1970 and 1985, 500 patients with urinary bladder carcinoma received external beam radiotherapy with curative intent at the Centre of Oncology in Kraków. The 5-year survival without evidence of cancer for T1 patients was 100% (5/5), for T2 48.7% (19/39), for T3 32% (128/400), and for T4 7.1% (4/56). In our patients the clinical T category was the only pretherapeutic prognostic parameter of statistical significance confirmed in uni- and multivariate analysis. The tolerance of therapy was poorer in patients who had partial transurethral resection of the bladder tumour performed prior to radiation therapy, and in those whose bladder volume was less than 200 ml. The additional irradiation of regional (pelvic) lymph nodes seemed to improve survival of patients with T3 bladder carcinoma.

External beam radiation treatment of urinary bladder carcinoma. An analysis of results in 203 patients

In a retrospective study, 203 patients with cancer of the urinary bladder were analysed concerning treatment outcome, survival and some prognostic factors. Radiotherapy with curative intent and a tumour dose of 66 Gy in 9 weeks with a 3 weeks' pause after 33 Gy was the planned treatment for 155 patients. Preoperative radiotherapy with a tumour dose of 40 Gy in 4 weeks was delivered to 28 patients, 4-6 weeks prior to cystectomy. Twenty patients with advanced disease received palliative radiotherapy with a tumour dose of 30 Gy in 2 weeks. A significant initial response to radiotherapy was obtained in 26.7% of the patients. The actuarial 5-year survival was 24% for patients treated with definitive radiotherapy only. The most important factors associated with survival in this radiotherapy group were stage (T-class), performance status and serum creatinine. Acute side-effects were common and in 18% of the patients deviation from the planned treatment was necessary.