HYPOFRACTIONATED RADIOTHERAPY FOR MUSCLE INVASIVE BLADDER-CANCER IN THE ELDERLY

Background and purpose: We have retrospectively investigated a hypofra ctionated regimen in a cohort of 65 elderly patients (median age 78 ye ars), designed to minimise acute radiation affects and maximise patien t tolerance and convenience in this frail group. Materials and methods : All patients were CT planned to a small volume. Once weekly fraction s (6 Gy) prescribed to the 100% isodose as a target minimum to 30 Gy ( n = 53) and 36 Gy (n = 12) were administered. Palliation of symptoms b efore, during, and 1 month from completion of radiotherapy were graded using the urinary and bowel symptom and toxicity index. Results: Fift y-five patients had persisting urinary symptoms following trans urethr al resection of bladder. Twenty-eight (51%) were completely palliated of symptoms and 7 (13%) noticed an improvement at a 1 month review. Ni nety-two percent of patients with haematuria were completely palliated compared to only 24% of those with dysuria and frequency. The median symptom free interval was 7 months (range 2-40 months). Median overall survival was 9 months (range 2-41 months). Twelve percent of patients required inpatient admission and only three failed to complete the pr escribed course due to bowel toxicity. Grade 3 acute urinary and bowel treatment related toxicity, were recorded in 18% and 9% of patients, respectively. In total, 43% of patients noticed a transient worsening of their presenting symptoms on treatment. To date no significant late toxicity (>grade 2) has been recorded. Conclusions: This regimen is g enerally well tolerated and offers reasonable palliation of symptoms o n an outpatient basis for this frail poor prognosis group. Haematuria is particularly well palliated although only a quarter of patients pre senting with dysuria and frequency were rendered symptom free. (C) 199 7 Elsevier Science Ireland Ltd.