A weekly hypofractionated radiotherapeutic schedule for bladder carcinoma in elderly patients: local response, acute and late toxicity, dosimetric parameters and pain relief

Abstract

Purpose: To investigate the early and late toxicity of a hypofractionated radiotherapy (RT) schedule to treat muscle-invasive bladder cancer in relation to radiation parameters according to the organs at risk. Methods: Forty-three patients with T2-T3 bladder carcinoma were irradiated with a weekly hypofractionated schedule with a total dose of 36 Gy in 6 fractions. Included in this study were elderly patients with poor performance status or unfit for surgery, while they complained of daily pain on urination. Pain evaluation was assessed with the use of the visual analogue scale (VAS) of pain, acute and late toxicities were assessed using the combined RTOG/EORTC criteria by using a dose of 50 Gy (D50), and the relapse free survival (RFS) was estimated from the date of recurrence. Results: No acute side effects were observed in the majority of the patients. Grade I rectal toxicity was registered in 67.4% of the patients, while grade II and III were noted in 30.25% and 2.3% of the patients, respectively. The worst late rectal toxicity was grade I in 30.2% of the patients. The VAS score of pain showed a significant improvement after the hypofractionated schedule. There was a significant correlation between acute and late toxicity on the one hand and the D50 dosimetric parameter on the other. The Kaplan-Meier plot showed a median RFS of 15 months, while age did not have any impact on RFS in patients above or under 75 years of age. Conclusion: The performed hypofractionated schedule permitted delivery of an increased radiation dose without increased toxicity, and with a high probability of local control for elderly patients with low survival perspective.