Split course radiotherapy for bladder cancer in elderly unfit patients

Area of Science:

• Oncology
• Radiation Oncology
• Urologic Oncology

Background:

• Bladder cancer treatment often requires radical approaches.
• Elderly patients or those with poor health may not tolerate standard radical radiotherapy.
• External beam radiotherapy (EBRT) offers an alternative for local control in select cases.

Purpose of the Study:

• To evaluate the efficacy and toxicity of split-course external beam radiotherapy for T1-T4 bladder cancer.
• To assess local tumor control and survival rates in patients unsuitable for radical radiotherapy.
• To determine the incidence of acute and late radiation-related complications.

Main Methods:

• Retrospective analysis of 89 patients with T1-T4 bladder cancer treated between 1980-1987.
• Split-course EBRT delivered in 10-12 fractions, mean dose 45 Gy, over a mean of 48 days.
• Assessment of tumor response, survival, and Radiation Therapy Oncology Group (RTOG) scored complications.

Main Results:

• Complete remission achieved in 31% (28/89) of patients, with higher rates in T1/T2 stages (56%).
• Median survival varied significantly by stage: 22 months (T1/T2), 10 months (T3a/T3b), and 8 months (T4).
• Acute radiation reactions (Grade 1-2) occurred in 60%; late complications (Grade 2-3) in 8% (5/62), with no severe morbidity.

Conclusions:

• Split-course EBRT can achieve local control in a subset of bladder cancer patients with contraindications to radical treatment.
• Treatment outcomes are strongly influenced by the initial tumor stage.
• The regimen demonstrated an acceptable toxicity profile with low rates of severe late complications.