Visceral complications of supervoltage radiotherapy for carcinoma of the bladder

Abstract

SUMMARYThirteen of 65 patients suffering from carcinoma of the bladder and treated by supervoltage radiotherapy developed late visceral complications. In 8 patients these lesions were in the bladder and in 7 the gastrointestinal tract was involved. The factors that are responsible for these lesions and the problems in their management are discussed.THE choice of treatment for carcinoma of the bladder may be a difficult problem and both surgery and radiotherapy have a place (Riches, 1963). Radiotherapy has been preferred for tumours which involve most of the mucosa of the bladder, are infiltrating deeply, or are anaplastic. Surgery in such cases requires a total cystectomy and urinary diversion and this procedure may be hazardous, although the mortality in experienced units is less than 5 per cent (Cordonnier, 1968). Recent improvements in techniques have also contributed towards this trend for radiotherapy and it is now possible to give a higher radiation dose without risk of skin damage. However, it is still difficult to screen other pelvic viscera and they may develop complications owing to radiation damage (Riches and Windeyer, 1960;Bloedorn, Young, Cuccia, Mercado, and Wizenberg, 1962; Caldwell, Bagshaw, and Kaplan, 1967). There is also a risk that radiotherapeutic complications may be mistaken for spread of the primary tumour and the patient denied further treatment. Many of these complications present as general surgical problems. CLINICAL MATERIALFrom 1960 to 1967, 65 patients with carcinoma of the bladder, admitted to the Urological Unit at the Hammersmith Hospital, were treated by supervoltage radiotherapy. Patients treated by surgery alone or patients referred to the Radiotherapy Unit from other hospitals were excluded from this study.Radiotherapy was given to patients in whom the tumour was ( a ) clinically or histologically infiltrating beyond the muscle, (b) multiple and not easily amenable to surgery, or (c) histologically poorly differentiated. Radiotherapy was also given where surgery was contra-indicated because of poor general condition.The patients were treated on the Linear Accelerator (8MeV.) and received a tumour dose of 4000-6250rads. The average duration of treatment was 4 weeks. The four-field technique was used except when there was a recent suprapubic scar, when three fields were used. The details of technique have been described previously (Morrison and Deeley, 1965).All patients were seen at regular intervals by both the Urological and the Radiotherapy Units. There was a minimal follow-up of 15 months. During treatment most patients develop mild to moderate symptoms of malaise, nausea, diarrhoea, frequency of micturition, and dysuria and these usually settle within a month after completion of treatment. Late complications were attributed to radiotherapy only if the histology of the lesions ( a ) showed no evidence of tumour and (b) showed radiation changes. Thirteen patients developed late complications (TabZe Z) and t developed t major lesions each, so that a total of 15 visceral co...

Pelvic complications after interstitial and external beam irradiation of urologic and gynecologic malignancy

“…Significant (grade 3, 4) bladder complications after definitive treatment to the bladder range from 5% to 15% [24][25][26][27][28][29]. A correlation between the severity of bladder symptoms and the radiation dose has been identified in several series.…”