Hypofractionated radiotherapy for patients with carcinoma of the bladder

In order to develop a low toxicity regimen of bladder radiotherapy for the palliation of patients with poor performance status we carried out a Phase II study of weekly 6 Gy fractions to a maximum dose of 30-36 Gy in 65 patie nts with T-2-T-4 bladder cancer (median age 81 years). A complete response was obtained in 23/37 (62%) assessable patients at cyst oscopy. Local control was achieved in 16/65 (25%) patients. The median surv ival of all 65 patients was 35 weeks, and the 2-year actuarial survival 21% . The main acute toxicity was urinary frequency as often as hourly at the p eak of the reaction (Radiation Therapy Oncology Group (RTOG) grade 3) in se ven patients, and urinary obstruction (RTOG grade 4) in one. The reactions may have been compounded by the effects of locally advanced tumour. Late bl adder toxicity amongst the 16 patients who were evaluable after 1 year incl uded four patients with persisting frequency, one with severe haematuria (R TOG grade), and one with a bladder capacity <100 mi (RTOG grade 4). One pat ient experienced RTOG grade 4 late bowel and bladder morbidity. Weekly 6 Gy fractions to a total dose of 30-36 Gy is a satisfactory palliat ive regimen for patients with advanced bladder cancer who cannot tolerate s tandard radical radiotherapy, but it may produce significant late bladder m orbidity.