Apoptosis in carcinoma of the bladder: Relation with radiation treatment results

Purpose: Radiotherapy is widely used in the treatment of bladder cancer. Th e search for biological parameters that could select patients who will resp ond to radiation treatment has become essential, The aim of this study is t o assess whether the pretreatment apoptotic index is useful in predicting l ocal control and survival in a group of bladder cancer patients treated by radiotherapy. Methods and Materials: Fifty-five patients with invasive bladder carcinoma treated between 1983 and 1996 were included in this study, Radiotherapy was given to a median dose of 66 Gy, mean 63.28 Gy, in 1.8-2 Gy daily fraction s. Apoptotic cells were studied in hematoxylin-eosin slides. Clinicopatholo gical tumor characteristcs were studied in relation to the apoptotic index, and as prognostic factors for local control and survival in both univariat e and multivariate analysis. Results: Pretreatment apoptotic indexes were related to tumor stage, mitoti c index, and Ki67 proliferation index. Five-year actuarial local control fo r the whole group was 45%, Patients with tumors showing low pretreatment ap optotic indexes had better local control (p < 0.037) and survival (p < 0.01 ) than highly apoptotic tumors. Tumor stage (T2 vs. T3-4) and the pretreatm ent apoptotic index were significant predictive factors for local control a nd survival in multivariate analysis. Conclusions: The pretreatment apoptotic index is useful in predicting the c linical outcome of bladder cancer patients treated by radiotherapy, Assessm ent of biological tumor characteristics could allow the selection of patien ts for different treatment strategies. (C) 1999 Elsevier Science Inc.