A randomized trial of hypofractionated schedules of palliative radiotherapy in the management of bladder carcinoma: Results of Medical Research Council Trial BA09

Citation
Gm. Duchesne 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 RAD O, 47(2), 2000, pp. 379-388
Citations number
13
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Onconogenesis & Cancer Research
Journal title
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
ISSN journal
03603016 → ACNP
Volume
47
Issue
2
Year of publication
2000
Pages
379 - 388
Database
ISI
SICI code
0360-3016(20000501)47:2<379:ARTOHS>2.0.ZU;2-Z
Abstract
Purpose: To compare the efficacy and toxicity of two hypofractionated radio therapy schedules for the improvement of local symptoms from muscle-invasiv e bladder cancer. Methods and Materials: A multicenter randomized. trial was conducted compar ing the efficacy and toxicity of two radiotherapy schedules (35 Gy in 10 fr actions and 21 Gy in 3 fractions) for symptomatic improvement in patients c onsidered unsuitable for curative treatment through disease stage or comorb idity. The primary outcome measures were overall symptomatic improvement of bladder-related symptoms at 3 months and changes in bladder- and bowel-rel ated symptoms from pretreatment to end-of-treatment and 3-month assessments . Overall symptomatic improvement was defined prospectively as the improvem ent in one bladder-related symptom of at least one grade at 3 months, with no deterioration in any other bladder-related symptom. Results: Five hundred patients were recruited, but data on symptomatic impr ovement at 3 months was only available on 272 patients. Of these, 68% achie ved symptomatic improvement (71% for 35 Gy, 64% for 21 Gy), with no evidenc e of a difference in efficacy or toxicity between the two arms. There was n o evidence of a difference in survival between the two schedules (hazard ra tio [HR] = 0.99, 95% CI 0.82-1.21, p = 0.933). Conclusion: This is the largest prospective trial to date in the palliative treatment of bladder cancer, and provides baseline data against which othe r results may be compared. The use of 21 Gy in 3 fractions appears as effec tive as 35 Gy in 10 fractions, although modest differences in survival, sym ptomatic improvement rates, and toxicity can not be reliably excluded. (C) 2000 Elsevier Science Inc.