OPTIMIZATION OF PALLIATIVE EXTERNAL BEAM RADIATION THERAPY FOR BLADDER CANCER

Purpose: To improve the efficacy of palliative radiation therapy for patients with bladder cancer (BC).

Materials and Methods: In the years 1990−2010, 90 patients with BC were treated with palliative external beam radiation therapy (EBRT) using three regimens: conventional fractionation in group 1 (n = 37), hypofractionation in group 2 (n = 22) and accelerated dynamic fractionation in group 3 (n = 31).

Results: The immediate efficacy of EBRT was evaluated taking into account rapid relief of local symptoms of disease. In group 1, a clinically significant response (hematuria relief) was achieved in 63,0 % cases, in group 2 — in 62,5 %, in group 3 — in 91,7 % cases. The 10-year follow-up showed that in group 1, the median survival was 21,8 ± 3,3 months; in groups 2 and 3, the median survival was 27,0 ± 7,8 and 32,6 ± 9,8 months, respectively. In group 2, an increase in the rate of acute radiation reactions was noted, whereas in group 3, palliative EBRT did not produce higher rates and severity of acute radiation reactions and complications.

Conclusion: Accelerated dynamic fractionation was found to shorten treatment times and to improve outcomes and quality of life for incurable patients with BC.

1. Чиссов В.И., Старинский В.В., Петрова Г.В. Состояние онкологической помощи населению России в 2009 году. М.: ФГУ «МНИОИ им. П.А. Герцена Росмедтехнологий», 2010; 196 с.

2. Holmang S., Borghede G. Early complications and survival following short-term palliative radiotherapy in invasive bladder carcinoma. J Urol 1996;155(1):100−2.

3. McLaren D.B., Morrey D., Mason M.D. Hypofractionated radiotherapy for muscle invasive bladder cancer in the elderly. Radiother Oncol 1997;43(2):171−4.

4. Salminen E.L. Inconventional fractionation for palliative radio-therapy of urinary bladder cancer. A retrospective review of 94 patients. Acta Oncol 1992; 31:449−54.

5. Wijkstrom H., Naslund I., Ekman P. et al. Shot-term radiotherapy as palliative treatment in patients with transitional cell bladder cancer. Brit J Urol 1991;67(1):74−8.

6. Jose C.C., Price A., Norman A. et al. Hypofractionated radiotherapy for patients with carcinoma of the bladder. J Clin Oncol (R Coll Radiol) 1999;11(5): 330−3.

7. Duchesne G.M., Bolger J.J., Griffiths G.O. et al. A randomized trial of hypofractionated schedules of palliative radiotherapy in the management of bladder carcinoma: results of medical research council trial BA09. Int J Radiat Oncol Biol Phys 2000; 47:379−88.