Evaluation of Acute Toxicity and Symptoms Palliation in a Hypofractionated Weekly Schedule of External Radiotherapy for Elderly Patients with Muscular Invasive Bladder Cancer

Abstract

Aim: To evaluate acute toxicity and symptoms palliation of a weekly hypofractionated 3DCRT schedule as radical treatment in elderly patients with organ confined bladder cancer cT1-2N0. Materials and Methods: Between February 2005 and June 2011, 58 prospectively selected patients diagnosed with organ confined bladder cancer were treated with external 3DCRT (4-field arrangement). All candidates were medically inoperable, with poor performance status, and with age ranged from 75 to 88 years (median 78). A dose of 36 Gy in 6 weekly fractions was prescribed. The primary study endpoints were the evaluation of haematuria, dysuria, frequency and pain palliation as well as the acute toxicity according to the RTOG/EORTC scale: an assessment was performed at baseline, during and 3 months after radiotherapy, while the maximum reported score was taken into account. Results: The gastrointestinal acute toxicities were 13/58 (22.4%) and 5/58 (5.6%), for grade I and II respectively. The genitourinary acute toxicities were 19/58 (32.7%) and 10/58 (17.2%), for grade I and II respectively. In terms of clinical outcome, 55/58 patients (94.8%) reported palliation of haematuria, while 19 out of 58 reported no change in frequency and dysuria. All patients reported significant improvement (P < 0.01) for pain, concerning the visual analogue score before and after radiotherapy. The median progression free survival was 14 months. Conclusions: The incidence of patient-reported acute toxicity following weekly hypofractionated external 3DCRT is low while the symptom palliation compares very favorably with other reported outcomes.

Palliative pelvic radiotherapy for symptomatic rectal cancer – a prospective multicenter study

“…Response rates were good for pain and rectal dysfunction as well although symptomatic improvement was slower and time courses more variable than for hematochezia. This is consistent with findings in other pelvic cancers, such as prostate [9], bladder [17] and gynecological cancers [18], and may reflect the fact that palliation of pain and rectal dysfunction requires a degree of tumor shrinkage. PPRT in this study was well tolerated, with primarily transient low-grade toxicities reported.…”

“…A randomized study of PPRT of bladder cancer comparing 35 Gy in 10 fractions to 21 Gy in 3 fractions, found no differences in efficacy or toxicity between the two arms (overall 68% of patients achieving symptomatic improvement) three months after treatment [24]. Among 58 patients with bladder cancer, PPRT delivered in weekly fractions of 6-36 Gy resulted in symptomatic response rates of 94% for hematuria and 100% for bladder-related pain [17]. A systematic review of PPRT of cervical cancer, including largely observational, retrospective studies, indicates that repeated large fractions of up to 10 Gy appear effective and well tolerated for control of bleeding (45-100% response rates), and may also have a positive effect on pelvic pain and vaginal discharge [18].…”

Palliative radiation therapy of bladder cancer

“…Авторы отмечают высокую эффективность лечения, прежде всего, за счет уменьшения гематурии (в 94,8 % случаев) и в меньшей степени (67,3 %) -по отношению к дизурическим яв-лениям. Острая токсичность I и II степеней тяжести (RTOG/EORTC) со стороны мочевыводящих путей от-мечена у 19 (32,7 %) и 10 (17,2 %) пациентов соответст-венно; острая токсичность со стороны кишечника I степени тяжести -у 13 (22,4 %) больных, II степе-ни -у 5 (8,6 %) [15].…”

“…Представлены результаты применения различных режимов ГФ: РОД 8,5-7,0 Гр, 2-3 фракции до СОД 17-21 Гр [8][9][10][11]; РОД 5-6 Гр, 1 или 2 фракции в неде-лю до СОД 30-36 Гр [12][13][14][15][16]; а также РОД 3,0-3,5 Гр, 10 фракций до СОД 30-35 Гр [9,17,18]. Как следует из опубликованных данных, применение подобных схем ДЛТ у больных РМП позволяет достичь палли-ативного эффекта в 40-70 % случаев.…”

“…Как следует из опубликованных данных, применение подобных схем ДЛТ у больных РМП позволяет достичь палли-ативного эффекта в 40-70 % случаев. В то же время в большинстве проведенных ретроспективных иссле-дований отмечена высокая токсичность некоторых вариантов крупнофракционной ДЛТ [12][13][14][15][16], в связи с чем у ряда авторов возникают сомнения в целесоо-бразности применения подобного лечения у больных РМП из-за высокого риска развития тяжелых ослож-нений [10].…”