Once weekly irradiation for carcinoma of the bladder

A dose-searching study was carried out treating selected elderly patients or patients with poor performance with bladder cancer with once weekly fractionation to determine an effective dose per fraction, and to evaluate acute and late effects resulting from this schedule.

Seventy patients with invasive transitional cell carcinoma of the bladder were entered in the study. The dose used was 36-39 Gy in six fractions over 35 days in 27 patients (Group 1). The remaining 43 patients were treated with 34.5 Gy in six fractions over 39 days (Group 2).

Six patients developed Grade 1-2 European Organization for Research on Treatment of Cancer (EORTC) bowel reaction. Three patients in Group 1 developed Grade 3 late bowel reaction and a fourth patient developed Grade 4 reaction requiring colostomy. However, only one patient in Group 2 developed Grade 3 reaction. The difference between the two groups was statistically significant (chi 2 = 3.794, p = 0.05).

The acute and late reaction as well as the 5-year free survival for patients in Group 2 compare favorably with daily treatment. We conclude that 34.5 Gy given over 39 days is a safe and effective treatment for selected patients with bladder cancer.