Radical Radiotherapy For Bladder Cancer Research Articles

Is Clinical Frailty Score Associated with Toxicity during Radical Radiotherapy for Bladder Cancer?

Purpose: The Clinical Frailty Scale (CFS) is a score (1–9) summarising a patient’s overall fitness and is associated with chemotherapy toxicity in some studies. We investigated if CFS was associated with toxicity in patients who received a course of treatment longer than 4 weeks for urothelial carcinoma.

Utilization of Radiotherapy for Bladder Cancer: Evolving referral and practice patterns in the general population

IntroductionDefinitive treatment for muscle invasive bladder cancer (MIBC) includes either cystectomy or radical radiotherapy (RT). Despite the growing evidence suggesting that cystectomy and RT may offer comparable survival benefit, utilization of RT and referral rate to radiation oncology (RO) have historically been low in routine practice.
 Objectives and ApproachThe aims were to describe the use of RT and RO referral patterns in the contemporary era. A retrospective cohort study was conducted by linking administrative treatment records with the Ontario Cancer Registry to identify all patients who received treatment with curative intent for bladder cancer in Ontario from 1994-2013. Physician billing records were linked to identify RO consultation before radical treatment. Practice patterns in the contemporary era (2009-2013) were compared with data from 1994 to 2008. Multilevel (patient-, surgeon- and hospital-level) logistic regression models were used to examine sociodemographic and organizational variation in referral to RO.
 ResultsIn total, 7461 patients underwent cystectomy or RT for bladder cancer in Ontario from 1994-2013; 5574 (75%) had primary cystectomy and 1887 (25%) primary had RT. Use of RT decreased from 43% in 1994 to 23% in 2008 and remained stable during 2009-2013 (23%). RO referral rate among all cases decreased from 46% in 1994 to 30% in 2008; however, the rates began to rise in the contemporary era from 31% in 2009 to 37% in 2013. A similar trend was seen in preoperative referral rate among patients treated with cystectomy (11% in 1994-1998, 9% in 1999-2008, and 14% in 2009-2013). Patient, surgeon, and hospital-level factors associated with preoperative referral to RO include older age, year of cystectomy, higher surgeon case volume, and teaching hospital.
 Conclusion/ImplicationsA minority of patients underwent curative intent therapy for bladder cancer received RT. Recent data suggest that referral rates to RO are increasing; future data will identify the extent to which this has altered practice. Collaborative efforts promoting multidisciplinary care and RO consultation at the urologist and hospital-level are warranted.

Comparison of Toxicity and Efficacy Outcomes of Capecitabine/MMC and 5FU/MMC in Patients with Bladder Cancer Treated with Radical Chemoradiotherapy

Aims: Concomitant 5FU/MMC with radical radiotherapy is the current standard of care for bladder conserving treatment of muscle invasive bladder cancer [1]. The Royal Sussex County Hospital protocol used 325 mg/m2 bd Monday to Friday of oral capecitabine, in place of week 1 and 4 infusional 5FU, which has the benefit of self-administration at home. Dosing was based on comparative 5FU dosing in the BC2001 trial and its use in oesophageal cancer. This audit evaluates our experience of using this protocol, compared to standard infusional 5FU, with radical radiotherapy for bladder cancer in West Kent.

Kent experience of radical chemoradiotherapy for muscle invasive bladder cancer.

373 Background: The BC2001 trial in 2012 showed concurrent chemoradiotherapy to be the new standard of care for bladder preserving treatment of muscle invasive bladder cancer. Addition of concurrent MMC and infusional 5FU showed a relative risk reduction of 33% in locoregional recurrence (James ND, Hussain S, Hall E et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366(16):1477–88.). This audit evaluates the experience across Kent in six hospitals adopting this protocol. Methods: 116 patients treated with radical radiotherapy for bladder cancer between January 2013 and December 2015 were retrospectively reviewed. 64 patients received radiotherapy alone due to contraindications to chemotherapy, performance status and patient choice. 52 patients received concurrent chemotherapy, the majority with 5FU/MMC and a subset with oral Capecitabine in place of infusional 5FU. Kaplan Meier and Log-Rank analysis of overall survival, local recurrence free survival and metastasis free survival were performed using SPSS. Results: Local recurrence free survival in the chemoradiotherapy group was 73% (95% CI 59-87%) compared to the radiotherapy group 61% (45-77) (p=0.27). There was a trend for greater metastasis free survival at 2 years, 63% (47-79) in the chemoradiotherapy group compared to 52% (38-66) in the radiotherapy group (p=0.21). Similarly, overall 2 year survival was 74% (60-88) and 59% (43-75) respectively (p=0.21). Conclusions: Our results showed a trend towards improved local control, distant control and increased overall survival in patients treated with concurrent chemoradiotherapy compared to radiotherapy alone. The differences did not meet statistical significance; however this was a small retrospective series with a relatively short median followup of 17.5 months. Treatment was well tolerated in our patient group. Overall, our data is in keeping with the results of the BC2001 trial (James ND, Hussain S, Hall E et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366(16):1477–88.)

Audit of Patient Pathway for those Receiving Radical Radiotherapy for Bladder Cancer

Audit of Patient Pathway for those Receiving Radical Radiotherapy for Bladder Cancer

Acute and Late Toxicity in Radical Radiotherapy for Bladder Cancer

Aims To evaluate the incidence, severity and kinetics of acute and late toxicity from bladder and bowels in patients with bladder cancer treated with radical radiotherapy. Materials and methods The retrospective analysis was based on 487 patients with T2, T3 bladder cancer, treated with radiotherapy between 1975 and 1995. The pelvis was irradiated electively in 303 patients; in the remaining patients, the bladder alone was treated. The mean total radiation dose to the bladder was 65.5 Gy. Various schedules of protracted, conventional and accelerated radiotherapy were used. The influence of selected factors on maximum acute toxicity and late toxicity was assessed. The kinetics of acute toxicity was also evaluated. The median follow-up was 76 months. Results Seven patients did not complete treatment due to excessive acute toxicity. The incidence of grade ≥3 acute bladder and bowel toxicity was 5 and 3%, respectively. The actuarial, 5-year incidence of grade ≥3 late bladder and bowel toxicity was 12 and 3%, respectively. The most important factors influencing acute toxicity were: T-stage ( P = 0.004) for the bladder and pelvic irradiation ( P = 0.044) and dose intensity ( P = 0.000) for the bowels. The latency of both early bladder and bowel toxicity was correlated with dose intensity. The most important factor influencing late bladder toxicity was acute toxicity score ( P = 0.000). Late bowel toxicity was also influenced by acute bowel toxicity ( P = 0.04). Conclusions The severity of acute bowel toxicity is related to pelvic irradiation and dose intensity. The severity of acute bladder toxicity depends on T-stage. The increase in dose intensity is associated with shorter latency to maximum acute bladder and bowel toxicity. The severity of acute bladder and bowel toxicity influences the risk of late effects from those organs.

Ultrasound Imaging to Assess Inter- and Intra-fraction Motion during Bladder Radiotherapy and its Potential as a Verification Tool

Aims Organ motion is the principle source of error in bladder cancer radiotherapy. The aim of this study was to evaluate ultrasound bladder volume measurement as a surrogate measure of organ motion during radiotherapy: (1) to assess inter- and intra-fraction bladder variation and (2) as a potential treatment verification tool. Materials and methods Twenty patients receiving radical radiotherapy for bladder cancer underwent post-void ultrasound bladder volume measurement at the time of radiotherapy treatment planning (RTP), and immediately before (post-void) and after receiving daily fractions. Results Ultrasound bladder volume measurement was found to be a simple and acceptable method to estimate relative bladder volume changes. Six patients showed significant changes to post-void bladder volume over the treatment course ( P < 0.05). The mean inter-fraction post-void bladder volume of five patients exceeded their RTP ultrasound bladder volume by more than 50%. Intra-fraction bladder volume increased on 275/308 (89%) assessed fractions, with the mean intra-fraction volume increases of seven patients exceeding their RTP ultrasound bladder volume by more than 50%. Conclusions Both day-to-day bladder volume variation and bladder filling during treatment should be considered in RTP and delivery. Ultrasound may provide a practical daily verification tool by: supporting volume limitation as a method of treatment margin reduction; allowing detection of patients who may require interventions to promote bladder reproducibility; and identifying patients with prominent volume changes for the selective application of more advanced adaptive/image-guided radiotherapy techniques.

Evaluating Inter-fractional Changes in Volume and Position during Bladder Radiotherapy and the Effect of Volume Limitation as a Method of Reducing the Internal Margin of the Planning Target Volume

Aims To quantify the inter-fractional variation in bladder volume and position during a course of bladder radiotherapy, and to assess the feasibility of reducing the planning target volume (PTV) internal margin using an empty bladder protocol. Materials and methods Weekly computed tomography scans were taken immediately after micturition on 15 patients undergoing radical radiotherapy for bladder cancer. Bladder volume and positional variation were compared by co-registration of the serial computed tomography scans with the initial planning scan and a single ‘full’ scan at the onset of treatment for each patient. A PTV was generated on the initial planning scan using both our departmental standard of 1.5 cm and a reduced 1 cm isotropic internal margin around the target (whole bladder) and the relative proportion of the bladder breaching the PTV using both margins compared. Results The mean post void residual volume from the planning scan was 112 cm 3 (standard deviation 42 cm 3). The mean weekly variation in bladder volume relative to the planning volume was 0–12% (standard deviation 20–34%) with no observable trends over time. No statistically significant differences were seen in the proportion of bladder breaching the 1.5 and 1 cm internal margin ( P = 0.18). Regression analysis showed that it is possible to ensure complete coverage of the bladder with a 1 cm margin, providing the volume did not exceed over 50% of the initial planning scan volume. Conclusion Using an empty bladder protocol and where on-line imaging is available it is feasible to reduce the internal margin of the PTV from 1.5 to 1cm, providing the volumes do not exceed >50% of the planning scan volume.

Radical Radiotherapy For Bladder Cancer: Retrospective Analysis of a Series of 459 Patients Treated in an Italian Institution

To contribute to the available evidence about the efficacy of exclusive radiotherapy for bladder cancer through a retrospective analysis of a large series of patients consecutively treated in a single institution. A total of 459 patients with UICC categories T1-T4, N0-Nx and M0 bladder cancer consecutively treated with radiotherapy alone with radical intent formed the clinical basis for this study. Many of them (and particularly the T1 cases) had poor medical conditions or were unfit for surgery. About half of the cases (54%) had a T2 tumour, and about 18% had T3-T4 disease. Eighty per cent of the cases received minimal doses in the target volume in the range 60-70 Gy; pelvic lymph nodes were treated in 34%. Simple radiotherapy techniques were used in most cases. Average follow-up for living patients was 4.4 years. Results were analysed according to number and type of relapses: overall survival, disease-specific survival, failure-free survival probability, acute and late toxicity (RTOG scale). Actuarial 5-year overall survival, disease-specific survival and failure-free survival rates at 5 years for the entire series were 36%, 56%, 33%, respectively. Age, T category (for all the end points) and tumour dose (only for failure-free survival) were significantly related to prognosis at multivariate survival analysis. Late enteric toxicity (6.1% of the cases) was significantly linked with the treated volumes (univariate analysis). Urinary late toxicity (23% of cases) was linked with age and T category (multivariate analysis). In both cases, toxicity was mostly Grade 1 or 2. The results of radiotherapy in this negatively selected series, accrued over a long period of time in patients treated with unsophisticated techniques, are reasonably good; they add to the evidence available to support the use of modern bladder-sparing programmes, including the association of chemo- and radiotherapy.

Long-term bladder, colorectal, and sexual functions after radical radiotherapy for urinary bladder cancer

Purpose To describe bladder, colorectal, and sexual dysfunctions among long time survivors after radical radiotherapy for urinary bladder cancer, and compare the results with a healthy control group. Materials and methods We identified 261 patients who had received radical radiotherapy for bladder cancer in the period 1994–2001. Patients were treated with a CT-based three-field technique with 60 Gy in 2 Gy fractions, 5 fractions/week. Sixty-two patients were alive and candidates for the study. For comparison, 185 controls were selected from the Danish National Register. Information was collected in an interview based on the LENT SOMA tables and questions concerning changes in daily life following radiotherapy. Results Fifty-three patients (85%), median age 77 years (range 51–84) entered the study. Median follow-up time was 29 months (range 18–103 months). There were 63 controls (34%). Fourteen percent of the patients reported that radiotherapy had moderate to severe impact on their present bladder function. Compared with the control group, significantly more patients had dysuria, and urethral stenosis, and were using bladder catheter. Twenty-nine percent of the patients reported moderate to severe impact on their present bowel function. Significantly more patients had diarrhoea, fecal urgency and fecal incontinence, and were using antidiarrhoea medication and sanitary pads. Twenty-five percent of the patients reported moderate to severe impact on their present sexual function. Impotence and lack of sexual desire were significantly higher among the male patients. Conclusions Following radical radiotherapy, most patients had a well functioning bladder, whereas 14% reported moderate to severe bladder dysfunctions. Due to the presence of bowel in the treatment field, radiotherapy is associated with considerable long-term intestinal side effects. Moreover, radiotherapy may result in sexual dysfunctions.

Impact of changes in bladder and rectal filling volume on organ motion and dose distribution of the bladder in radiotherapy for urinary bladder cancer

Purpose To determine the impact of filling volume changes of the urinary bladder and rectum on organ motion and dose distribution of the bladder and rectum during radical radiotherapy for bladder cancer and to calculate the internal margins to secure target coverage. Methods and materials In 15 patients with muscle-invasive bladder cancer, a planning CT scan was performed with a bladder and rectal catheter, followed by three immediate CT scans with various filling of the urinary bladder and rectum. After 20 fractions, a fifth CT scan, without catherization, was performed. In each CT study, the bladder and rectum volumes were delineated and matched to the planning CT scan to measure the organ motion and calculate internal margins. These margins were compared with an isotropic standard margin of 2 cm. Dose–volume histograms were analyzed to describe the dose distribution in the bladder and rectum corresponding to various filling volumes. Results Bladder movement was most pronounced in the anterior and cranial directions. The internal margins required to cover the bladder movements due to filling of the bladder and rectum in 87% of the patients were 2.4 cm in the anterior, 1.1 cm in the posterior, 3.5 cm in the cranial, 0.5 cm in the caudal, and 1.3 cm in the lateral direction. Conclusion The filling volumes of the bladder and rectum have a large impact on bladder movements, especially in the anterior and cranial directions. This should be included in the internal target volume with the introduction of anisotropic margins in conformal radiotherapy for bladder cancer.

Relative importance of sources of symptom-induced distress in urinary bladder cancer survivors.

The influence of specific symptoms on emotions and social activities in the individual patient varies. Little is known about this variation in urinary bladder cancer survivors (in other words, about the relative importance of sources of symptom-induced distress). We attempted to enroll 404 surgical patients treated with cystectomy and a conduit or reservoir in four Swedish towns (Stockholm, Orebro, Jönköping, Linköping), 101 surgical patients treated with cystectomy and orthotopic neobladder at the Herlev Hospital in Copenhagen, Denmark, and 71 patients treated with radical radiotherapy for bladder cancer, as well as 581 men and women controls in Stockholm and Copenhagen. An anonymous postal questionnaire was used to collect the information. A total of 503 out of 576 (87%) treated patients and 422 out of 581 (73%) controls participated but 59 patients were excluded. The primary source of self-assessed distress among cystectomised patients was compromised sexual function; reduced intercourse frequency caused great distress in 19% of the conduit patients, 20% of the reservoir patients and 19% of the bladder substitute patients. The primary source of self-assessed distress in patients treated with radical radiotherapy was symptoms from the bowel; 17% reported great distress due to diarrhoea, 16% due to abdominal pain, 14% due to defecation urgency and 14% due to faecal leakage. The highest proportion of subjects being distressed was 93% (substantial: 43%, moderate: 29% and little: 21%) for treated upper or lower urinary retention (indwelling catheter or nephrostomy). The distress caused by a specific symptom varies considerably and the prevalence of symptoms causing great distress differs between treatments in bladder cancer survivors. It is possible that patient care and clinical research can be made more effective by focusing on important sources of symptom-induced distress.

Distressful symptoms after radical radiotherapy for urinary bladder cancer

Background: Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function. Here we studied symptoms, symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy. Materials and methods: We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995. For comparison, 325 patients treated with radical cystectomy and urostomy, continent or non-continent, during the same period and 460 individuals randomly selected from the general population were included. Information was collected by means of an anonymously answered postal questionnaire to avoid investigator-related bias. Results: Answers were obtained from 58 (82%) radiated patients, 251 (85%) cystectomized patients and 310 (71%) population controls. Of the radiated patients, 74% reported little or no distress from symptoms from the urinary tract, 38% had had intercourse the previous month and 57% (men) reported they had ejaculated. Among the cystectomized patients, 13% had had intercourse and 0% (men) had ejaculated. Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32% of the radiated patients, 24% of the cystectomized patients and 9% of the population controls. After radical radiotherapy, 46% of the patients were willing to accept some risk of decreased survival to become symptom-free. Conclusions: About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract. The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable.

URETHRAL RECURRENCE AFTER RADICAL RADIOTHERAPY FOR BLADDER CANCER

Following cystectomy for bladder cancer, orthotopic reconstruction may result in a decreased risk of urethral recurrence compared to cutaneous diversion. We evaluate the rate of urethral recurrence after radical external beam radiotherapy. We reviewed the records of 214 men who had received radical radiotherapy at a single center from 1990 to 1995. Patients treated with chemotherapy were excluded from study. A total of 214 men (median age 69 years, range 39 to 86) underwent radical radiotherapy for cure. Tumor stages were T1 in 7%, T2 in 41%, T3 in 42% and T4a in 10% of the patients. Median followup was 32 months (range 1 month to 8.4 years) and 5-year survival rate was 30%. Urethral recurrence developed in 7 (3.2%) cases and was detected within 18 months (median 10 months, range 3 months to 5 years) of followup in 5. In 2 of these 7 cases recurrence developed in the prostatic urethra, and when these 2 cases were excluded from analysis the recurrence rate decreased to 2.3%. A total of 64 men completed 5-year followup, with a 4.7% rate of urethral recurrence (3.1% excluding prostatic urethral recurrence). Multifocal disease, bladder neck involvement, prostatic disease and cis were possible risk factors for urethral recurrence. The risk of urethral recurrence after radical radiotherapy for transitional cell carcinoma of the bladder is comparable with that reported after orthotopic reconstruction. It is not possible to exclude completely that men at higher risk were offered cystectomy, but the data are consistent with the suggestion that continued contact with urine may be protective.

A population-based study of the use and outcome of radical radiotherapy for invasive bladder cancer

Purpose: The objective of this study is to describe the use and outcome of radical radiotherapy for bladder cancer in the province of Ontario, Canada, between 1982 and 1994. Methods: Electronic records of invasive bladder cancer (ICD code 188) from the Ontario Cancer Registry were linked to surgical records from all Ontario hospitals and radiotherapy (RT) records from all Ontario cancer centers. We identified cases receiving radical RT by selecting RT records containing “bladder” or “pelvis” anatomic region codes and a radical or curative intent code (or dose > 39.5 Gy if intent missing). We identified cases receiving salvage total cystectomy by selecting total cystectomy procedure codes occurring at any time beyond 4 months from the start of radical RT. We used life table methods to compute the following: the time from diagnosis to radical RT, the time from radical RT to salvage cystectomy, overall and cause-specific survival from radical radiotherapy to death, and overall and cause-specific survival from salvage cystectomy to death. We modeled the factors associated with time to death, time to cystectomy conditional on survival, and time to cystectomy or death, whichever came first, using Cox proportional hazards regression. Results: From the 20,906 new cases of bladder cancer diagnosed in Ontario from 1982 to 1994, we identified 1,372 cases treated by radical radiotherapy (78% male, 22% female; mean age 69.8 years). The median interval to start of radical RT from diagnosis was 13.4 weeks. Ninety-three percent of patients were treated on high-energy linacs, and the most common dose/fractionation scheme was 60 Gy/30 (31% of cases). Five-year survival rates were as follows: bladder cancer cause-specific, 41%; overall, 28%; cystectomy-free, 25%; bladder cancer cause-specific following salvage cystectomy, 36%; overall following salvage cystectomy, 28%. Factors associated with a higher risk of death and a poorer cystectomy-free survival were histology (squamous or nonpapillary transitional cell carcinoma [TCC]) and advanced age. Conclusion: This population-based study confirms previous institutional studies and clinical trials and shows that radical RT has a curative role in the management of invasive bladder cancer and allows about one-quarter of patients receiving radiotherapy to survive 5 years while retaining the bladder. Salvage cystectomy following RT provides a chance of cure at the time of bladder relapse.

Sexual function following radical radiotherapy for bladder cancer

Background and purpose: The effect of radical radiotherapy (RT) for bladder cancer on sexual function has not been previously investigated. The current study was designed as a pilot to assess sexual function in males pre- and post-radiotherapy. Materials and methods: An anonymous questionnaire was devised to examine the following sexual domains: libido, frequency of sexual function, erectile capacity, orgasm and ejaculation in the 6 months prior to radiotherapy and following treatment. Serum testosterone, FSH and LH were measured in 10 patients. Results: Eighteen patients completed the questionnaire from 10 to 56 months following irradiation, 13 of whom were able to achieve an erection prior to RT. Over half of these patients noted a decline in the quality of erections after RT, with a similar proportion noting decreased libido and frequency of sexual activity. Three patients lost the ability to have any erections whatsoever. Of the 10 patients retaining erectile capacity, three noted reduced frequency of early morning erections suggesting a physical aetiology, five had decreased frequency of ejaculation and four had reduced intensity of orgasms. Seventy-one percent (12/17) felt their sex life was worse following RT but only 56% (9/16) were concerned about the deterioration. Testosterone levels were normal in all but one patient. Conclusions: Radical RT to the bladder can cause a decrease in sexual function in males.

Carbogen and nicotinamide in the treatment of bladder cancer with radical radiotherapy

Carbogen and nicotinamide have been evaluated in a phase II study as hypoxia-modifying agents during radical radiotherapy for bladder cancer using a standard daily 20-fraction schedule. Three groups of patients have received (a) nicotinamide alone, given orally in a dose of 80 mg kg(-1) daily with 52.5 Gy in 20 fractions over 4 weeks, (b) carbogen alone, with 50 Gy in 20 fractions over 4 weeks, and (c) carbogen and nicotinamide, with 50-52.5 Gy in 20 fractions over 4 weeks. Ten patients were treated in each group. All patients completed carbogen and radiotherapy as prescribed, but only 45% completed daily nicotinamide over the 4-week treatment period. The end points of this study were acute bowel and bladder morbidity and local control at cystoscopy 6 months after treatment. An expected level of acute bowel and bladder morbidity was seen that reverted to normal in most patients by 12 weeks with no difference between the three treatment groups. Complete response rates at 6 months were seven out of ten (100%) in the nicotinamide alone group, nine out of ten (90%) in the carbogen alone group and seven out of ten (70%) in the carbogen and nicotinamide group. It is concluded that carbogen and nicotinamide may improve the results of daily fractionated radiotherapy in bladder cancer and that further evaluation is required.

Split course radical radiotherapy for bladder cancer in the elderly: nonsense or commonsense? A report of 76 patients.

The role of split course radical radiotherapy in bladder cancer is controversial. We have pursued such a policy in elderly patients in view of the unpredictable toxicity of radical radiotherapy in this group. Between 1987 and 1992, 76 patients were treated in this way, with 2 weeks' treatment followed by a 3-week gap. Patients were then reassessed and, if considered fit enough, a further 2 weeks of treatment was given. Fifty-three patients (mean age 78.4 years) completed treatment and 23 (mean age 78 years) received phase 1 alone. Thirty-seven of 53 patients completing treatment has a follow-up cystoscopy at 6 months. Twenty-five percent of all patients, 36% of those completing treatment, and 51% of those undergoing cystoscopy, achieved a complete response. The reasons for not completing treatment and not being followed up cystoscopically are examined. We feel that this policy has a role in selected patients whose fitness to tolerate a conventional radical course of radiotherapy is in doubt.

THE PLACE OF RADIATION THERAPY AS DEFINITIVE TREATMENT OF BLADDER CANCER

THE PLACE OF RADIATION THERAPY AS DEFINITIVE TREATMENT OF BLADDER CANCER

The Quality of Life after Radical Radiotherapy for Bladder Cancer

The quality of life in 72 patients who had shown a complete response to radiotherapy, using a modified bladder symptom score and the Nottingham health profile, was compared with the quality of life in a similar control group matched for age and sex. There was no significant difference in either group. The records of 69 patients who had undergone post-radiation salvage cystectomy were reviewed, looking specifically at surgical complications. There were 3 post-operative deaths (5%), 3 pulmonary emboli and 3 fistulae--with some overlap of complications. Five patients who underwent cystectomy for intractable symptoms in the apparent absence of recurrent tumour were found to have residual cancer in the excised specimens.