Palliative radiation therapy of bladder cancer

Introduction. One of the problems of urologic oncology is that patients with bladder cancer (BC) show up late for appointments, which leads to increased numbers of patients with advanced cancer stages accompanied by symptoms considerably reducing their quality of life. In most similar cases, external beam radiation therapy (EBRT) may be given with palliative intent to lessen or relieve the local symptoms of disease and to deliver the highest possible dose of radiation to bladder tumor.

Objective: to assess the efficacy and toxicity of palliative EBRT in patients with BC.

Materials and methods. Outcomes of palliative EBRT that had been given to 103 patients with BC were analyzed. Poor somatic health status of these patients caused by underlying disease or accompanying pathology made radical treatment impossible.

Results. During EBRT treatment, hematuria was stopped in 56 (72.7 %) and reduced in 21 (27.3 %) patients. After completing EBRT, bladder pain syndrome was relieved in 13 (76.5 %) of 17 patients, but in 1 patient the pain got worse, and in 3 (17.6 %) patients no changes in this symptom occurred. Acute bladder reactions were observed in 37 (35.9 %) patients: grade I–II (RTOG) in 32 (31.1 %) patients and grade III–IV in 5 (4.8 %) patients. Acute grade I–II rectitis was noted in 10 (9.7 %) patients. Late grade I–II bladder complications (RTOG/EORTC) occurred in 16 (15.5 %) patients, and late rectal complications in 2 (1.9 %) patients. Due to relief of local symptoms and improvement of somatic health status in 16 (15.5 %) patients, it was possible to perform radical treatment for BC. At 12 months after treatment, objective tumor response was achieved in 34 (33.0 %) and stable disease in 14 (13.6 %) BC patients.

Conclusion. Radiation therapy is an effective method of palliative care of patients with advanced BC and marked local symptoms. In most cases, EBRT can help stop or reduce hematuria and pain as well as improve quality of patient life. Therefore, it is necessary to develop methods of effective palliative care for patients with complicated advanced BC. A personalized approach to optimize programs palliative treatment of BC is a promising direction for further research.