67. Radical radiotherapy of muscle-invading bladder cancer (BC): a retrospective analysis of 49 patients

Growing interest in the use of combined modality approaches for bladder-sparing procedures force radiation oncologists to optimise methods of radical radiotherapy. Since treatment policies have changed considerably over the last years, in this retrospective study we analysed feasibility of radical radiotherapy and outcomes of patients treated in our institution between 1992 and 2000. Study group comprised 49 consecutive BC patients aged 43 to 80 years (median 71), including three cases with clinically involved pelvic lymph nodes. There were 45 urothelial, and four other types of cancer (grade 1- four, 2 – 21, 3-nine, and unknown -14 cases). Six patients were referred for radiotherapy after nonradical operation. Treatment was delivered with the use of 60Co or LA five days a week, without planned interruptions. Thirty-two patients received elective irradiation of the pelvic lymph nodes to the dose 40 to 48 Gy, followed by the boost to the bladder to the total dose 60 to 66 Gy. Seventeen patients received total dose of 58 to 62 Gy to the bladder and perivesical tissue. Fraction doses ranged from 1.8 to 2.0 Gy. Treatment was prematurely stopped due to disease progression (PD), patient refusal, uraemia, in one case each, and intractable diarrhoea in six cases. After a median follow-up of 14 months (range 1 – 102) 23 patients died of PD. Median survival in the entire group is 159 months. Results of this study confirm relative efficacy of radiotherapy in BC. Further refinement of radiotherapy techniques is warranted to improve the outcome.