Radical Radiotherapy In Patients Research Articles

Vulvar cancer. The contribution of radiotherapy to the treatment of the disease

The aim of the study was to analyze and summarize the available literature data on the modern radiotherapy techniques, indications for radiotherapy (preoperative, radical, postoperative radiation therapy), treatment volumes at different disease stages, and principles of drug and accompanying therapy for patients with vulvar cancer. Material and Methods. The literature review was based on the clinical recommendations of the Ministry of Health of the Russian Federation and National Comprehensive Cancer Network (NCC N), as well as on the search of sources in PubMed and Cochrane Library systems. Literature sources and publications from 2005 to 2023 were included. Results. This contribution outlined the main indications for preoperative, postoperative and radical radiotherapy in patients with vulvar cancer, as well as the basic principles of drug treatment and correction of complications. Potential risk factors for postoperative disease recurrence were identified, the volumes of irradiation at each treatment mode were analyzed, and the feasibility of using brachytherapy in patients with vulvar cancer was discussed. Conclusion. To date, there are recommendations, guidelines for the management of patients with vulvar cancer, as well as clinical trial results. Understanding of the principles of prescribing treatment for vulvar cancer patients can improve local control, overall and recurrence-free survival, and the use of modern radiotherapy techniques will enshure an acceptable quality of life in these patients.

Vulvar cancer. The contribution of radiotherapy to the treatment of the disease

The aim of the study was to analyze and summarize the available literature data on the modern radiotherapy techniques, indications for radiotherapy (preoperative, radical, postoperative radiation therapy), treatment volumes at different disease stages, and principles of drug and accompanying therapy for patients with vulvar cancer. Material and Methods. The literature review was based on the clinical recommendations of the Ministry of Health of the Russian Federation and National Comprehensive Cancer Network (NCC N), as well as on the search of sources in PubMed and Cochrane Library systems. Literature sources and publications from 2005 to 2023 were included. Results. This contribution outlined the main indications for preoperative, postoperative and radical radiotherapy in patients with vulvar cancer, as well as the basic principles of drug treatment and correction of complications. Potential risk factors for postoperative disease recurrence were identified, the volumes of irradiation at each treatment mode were analyzed, and the feasibility of using brachytherapy in patients with vulvar cancer was discussed. Conclusion. To date, there are recommendations, guidelines for the management of patients with vulvar cancer, as well as clinical trial results. Understanding of the principles of prescribing treatment for vulvar cancer patients can improve local control, overall and recurrence-free survival, and the use of modern radiotherapy techniques will enshure an acceptable quality of life in these patients.

Value of 18F-fluorocholine PET/CT in predicting response to radical radiotherapy in patients with localized prostate cancer

PurposeThis study aims to establish whether metabolic parameters obtainable from FCH PET/CT can predict long-term response to radical radiotherapy (rRT) in patients with localized prostate cancer (PCa). MethodsDrawing on a single-center database, we retrospectively reviewed the pre-treatment FCH PET/CT scans of 50 patients who underwent rRT between 2012 and 2017. Patients were enrolled if they had a follow-up of at least 3 years after rRT. Various metabolic parameters were considered for each PET/CT, including FCH multifocality. rRT was administered to all patients for a total equivalent dose of 76–80 Gy, using a standard or hypofractionated schedule. Patients were classified as disease-free (DF) if their PSA levels after rRT rose by <2 ng/mL vis-à-vis their PSA nadir, or as not disease free (NDF) if their PSA levels rose by more than 2 ng/ml. ResultsA multifocal FCH uptake in the prostate gland was identified in 27 patients (54%). At 3-year follow-up, 37 patients (74%) were judged DF, and 13 (26%) were NDF. The SUVmax and SUVmean, and the sum of the two values in all FCH foci in the prostate gland were significantly higher for NDF patients than for DF patients (all p < 0.005). The sum of the TLCKA levels in all FCH foci was likewise significantly higher in patients who were NDF than in those found DF (median 54.5 vs. 29.4; p < 0.05). At univariate analysis, the most of PET-metrics and Gleason Score were predictors of biochemical relapse after 3-year follow-up (all p < 0.05). ConclusionHigher SUVs seems predict a worse outcome for patients with multifocal intraprostatic lesions who are candidates for rRT.

FDG-PET/CT scan assessment of response 12 weeks post radical radiotherapy in oropharynx head and neck cancer: The impact of p16 status

PurposeTo evaluate the predictive value of FDG-PET/CT for detection of residual disease after radical radiotherapy for patients with squamous cell carcinoma (SCC) of the oropharynx, comparing p16 positive (+) versus p16 negative (−) disease. Methods and materialsA retrospective analysis of patients with SCC of the oropharynx at our institution treated with radical radiotherapy between 2012 and 2016 was performed. The primary and lymph node metabolic responses were evaluated independently on the post-treatment FDG-PET/CT. The reference standard was pathology when available, subsequent post-treatment FDG-PET/CT results or clinical follow-up. ResultsMedian follow-up time was 32 (30–34) months. 556 patients had p16+ disease and 92 had p16− disease. The median time of post-treatment FDG-PET/CT was 96 (45–744) days after radiotherapy completion: 68% had complete metabolic response (CMR) defined as mild non-focal or no uptake, 10% residual primary disease, 11% residual regional lymph node disease, 5% residual primary and regional disease, and 6% distant metastatic disease. The local positive predictive value (PPV) was 26% for p16+ versus 54% for p16− (p = 0.01) and the regional PPV was 31% for p16+ versus 58% for p16− (p = 0.01). The local negative predictive value (NPV) was 100% regardless of p16 status and the regional NPV was 100% for p16+ versus 99% for p16− (p = 0.33). For p16+ cases, regional specificity was 76.2% versus 91.1% (p = 0.0003), local PPV was 0 versus 30% (p = 0.06) and the regional PPV was 12% versus 35% (p = 0.06) for FDG-PET/CT scans performed at ≤12 weeks versus >12 weeks. Five-year overall survival for those with CMR was 87% versus 51% without CMR (p ≤ 0.001). ConclusionsMetabolic response on post-treatment FDG-PET/CT has excellent NPV regardless of p16 status. The PPV is significantly lower in those with p16+ versus p16− disease, with a significantly reduced regional specificity and a trend towards inferior predictive value if performed ≤12 weeks. CMR predicts for a significantly improved overall survival.

Comparison of Chemoradiotherapy and Radical Radiotherapy in Patients With Cervical Cancer

Introduction: The current study aimed at comparing the results of radical radiotherapy (RT) or chemoradiotherapy (CRT) in patients with cervical cancer and evaluating the prognostic factors. Methods: CRT is the standard of care for locally advanced cervical cancer with the five-year survival rate of 30%–80%. In 1978-2006, a total of 716 patients with cervical cancer stage IB2-IVB were retrospectively analyzed for RT and CRT. In intracavitary brachytherapy, the median dose was 24 Gy and follow-up was 78 months. CRT was treated with 45 Gy external radiotherapy with cisplatin 40 mg/m2 given once a week. Results: The five-year pelvic control rate was 56.2% in the radical RT arm and 75.8% in the combined arm (P=0.01); disease-free survival and overall survival rates were 47%-56.3% (P=0.09) and 44.9%-52.5% (P=0.03), respectively. Treatment failure was detected in 317(50.5%) of 627 patients in the RT arm and in 30 (33.7%) of 89 patients in the CRT arm (Chi-squared value=8.86, P&lt;0.01). Treatment failure rate was high in the 1st two years. Distant metastases were detected in 116 patients in the RT and 17 patients in the CRT arms. Hematological side effect rates in the CRT arm -anemia, thrombopenia, and leukopenia- were 33.7%, 13.5%, and 28.1%, respectively. The prevalence of rectitis, cystitis, and skin and subcutaneous fibrosis in the RT arm was 9.4%, 4.8%, and 2.2%, and in the CRT arm was 12.4%, 11.2%, and 13.5%, respectively. Conclusions: CRT increased pelvic control and overall survival rate based on the findings; it can be the preferred treatment modality because of its high response rate and acceptable toxicity.

Radical radiotherapy in patients with cervix uteri carcinoma: experience of Ondokuz Mayis University

BackgroundRadical radiotherapy is the standard treatment for patients with locally advanced cervix uteri carcinoma (FIGO stage IB2–IVA). Worldwide, incidence and mortality rates vary among regions because of differences in lifestyles and treatment standards. Herein, we evaluated the outcomes of radical radiotherapy in patients with locally advanced cervix uteri carcinoma from the middle Black Sea region of Turkey.MethodsWe retrospectively reviewed the records of 64 consecutive patients with locally advanced cervix uteri carcinoma who were treated from January 2013 to 2016 in our radiation oncology department. All patients staging and radiotherapy planning were performed with modern imaging techniques including magnetic resonance imaging and positron-emission-tomography/computed tomography before radical radiotherapy. Thereafter, all of them were treated with external beam radiotherapy and concurrent cis-platinum-based chemotherapy followed by three-dimensional intra-cavitary high-dose-rate brachytherapy.ResultsThe median age at diagnosis was 54.5 years. The median follow-up period was 21 months. Acute grade 3 toxicity was detected in 3.1% of patients. Late toxicity was not detected in any patient. The 1- and 3-year progression-free survival rates were 83.6 and 67.5%, respectively. The 1- and 3-year overall survival rates were 95.7 and 76.9%, respectively. The most important prognostic factor was the FIGO stage. Distant metastasis was the most common cause of death in patients with locally advanced cervix uteri carcinoma despite radical radiotherapy.ConclusionsIn patients with locally-advanced cervix uteri carcinoma from the middle Black Sea region of our developing country, acceptable toxicity and survival rates are achieved similar to the recent literature from developed countries with using of modern staging, planning and radical radiotherapy techniques. However, recurrence was mostly in the form of distant metastases and further investigations on systemic therapies are required.

Outcome of Palliative and Radical Radiotherapy in Patients with Oral Squamous Cell Carcinoma - a Retrospective Study.

The treatment selection for the oral squamous cell carcinoma remains controversial. Radiation therapy or surgical excision of the lesion can be applied as the sole treatment or it can be used in combination with other treatment modalities. Radiotherapy is considered to be the safest of all the treatment modalities and can be used in several situations for oral and oropharyngeal cancers. The aim of this study was to evaluate the survival outcome differences in patients treated with radical and palliative radiotherapy as the primary treatment modality. The study included a total of 47 patients with oral cancer reporting to our hospital between years 2009 to 2010. The age group for the selected patients was more than 65 years, treated with radical and palliative radiotherapy with no prior surgical interventions. Patients were evaluated till Dec 2013 for overall survival time. Twenty nine patients were treated with radical radiotherapy as main stay of treatment, out of which 21 died during the follow up time with median survival of 352 ± 281.7 days with 8 patients alive. All the 16 patients were dead who received palliative radiotherapy with a median survival time of 112 ± 144.0 days. This retrospective study showed improved overall survival time, loco regional control rates and reduced morbidity in patients treated with radical radiotherapy when compared to patients treated with palliative radiotherapy.

Partial-Body Irradiation in Patients with Prostate Cancer Treated with IMRT Has Little Effect on the Composition of Serum Proteome.

Partial body irradiation during cancer radiotherapy (RT) induces a response of irradiated tissues that could be observed at the level of serum proteome. Here we aimed to characterize the response to RT in group of patients treated because of prostate cancer. Five consecutive blood samples were collected before, during, and after the end of RT in a group of 126 patients who received definitive treatment with a maximum dose of 76 Gy. Serum peptidome, which was profiled in the 2000–16,000 Da range using MALDI-MS. Serum proteins were identified and quantified using the shotgun LC-MS/MS approach. The majority of changes in serum peptidome were detected between pre-treatment samples and samples collected after 3–4 weeks of RT (~25% of registered peptides changed their abundances significantly), yet the intensity of observed changes was not correlated significantly with the degree of acute radiation toxicity or the volume of irradiated tissues. Furthermore, there were a few serum proteins identified, the abundances of which were different in pre-RT and post-RT samples, including immunity and inflammation-related factors. Observed effects were apparently weaker than in comparable groups of head and neck cancer patients in spite of similar radiation doses and volumes of irradiated tissues in both groups. We concluded that changes observed at the level of serum proteome were low for this cohort of prostate cancer patients, although the specific components involved are associated with immunity and inflammation, and reflect the characteristic acute response of the human body to radiation.

Remote Results of Intraarterial Chemotherapy with Local Hyperthermia in the Treatment of Patients with Nasal and Paranasal Sinuses Cancer

ABSTRACT Aim: To study remote results and the role of intraarterial chemotherapy with local hyperthermia in the treatment of nasal and paranasal sinus cancer patients. Methods: 209 patients were treated over the period 2000 - 2008. T3 stage was diagnosed in 106 patients (51.4%) and T4 stage in 103 (48.6%) patients. Squamous cell carcinoma was found in 71.3% patients. Patients were divided into 4 groups: 1) intraarterial chemotherapy with local hyperthermia and radiotherapy (58 patients; 2) intraarterial chemotherapy and radiotherapy (48 patients;, 3) systemic chemotherapy and radiotherapy (58 patients); 4) radiotherapy followed by surgery (45 patients). We used the following regimen: cisplatin 100 mg, fluorouracil 3000 mg and doxorubicin 60 mg. In 1st group 58 patients received local UHF–hyperthermia with the frequency of 40 MHz increasing the temperature up to 41-43°C in the tumour. Patients of the 1st and 2nd groups, received intraarterial chemotherapy with ligation and catheterization of external carotid artery. All patients received telegammatherapy, dose 40-60 Gy. For appreciating of the remote results SPSS-16 statistical methods were used. Results: Continuous regional intraarterial chemical induction in the background of local hyperthermia significantly increased the results of treatment. Surgical treatment was made to 128 (61.2%) patients at second grade of complex therapy. In the 1st group of patients 3-year survival rate was 83.4%, and 5-year survival rate was 73.0%. In the 2nd group those rates were 80.4% and 66.7%, respectively. In the 3rd group those rates were 68.2% and 60.6%, respectively. In the 4th group those rates were 68.1% and 54.1%, respectively. In the study of long-term treatment outcomes of patients receiving integrated and combined treatment it was found that the recurrence rate in the 1st and 2nd groups compared with the 3rd and 4th groups of patients differed significantly. So in the 1st group these figures were 32.4% in the 2nd group 38.1%, and in the third group recurrence was seen in 45.4% of patients. In the 4th group this figure increased further and was observed in 51.3% of patients. Conclusions: Thus, neoadjuvant continuous intraarterial chemotherapy with local UHF-hyperthermia and radiotherapy in the 1st group of patients allowed us to increase significantly the remote results compared with those in the 3rd group who received systemic chemotherapy. Disclosure: All authors have declared no conflicts of interest.

Outcome of the radical hypofractioned radiotherapy treatment in patients with stage I and II of non-small cell lung cancer

AbstractIntroduction: Surgery is the treatment of choice in stage I and II non-small-cell lung cancer (NSCLC). In the management of patients who are medically unfit to tolerate surgical intervention or who refuse surgery, radiotherapy is an acceptable alternative. We have performed a retrospective analysis of the effectiveness of radical radiotherapy in patients with early stage NSCLC treated over a period of 4 years.Methods: Thirty nine patients treated with radiotherapy of radical intent were identified. All patients received hypofractionated radiotherapy with a total dose of 55Gy in 20 fractions.Results: The median survival of all cases was 29 months. The one and two-year survival was respectively 61 % and 41%. The median survival of patients ≥75 years was 28 months, and age was the only prognostic factor identified in this analysis that affected survival.Conclusions: The presented survival results are consistent with those from other series published in the literature. At present, radical radiotherapy is often offered to patients with medically inoperable stage I and II NSCLC or those who decline surgery. But there is emerging evidence that some new techniques like stereotactic radiotherapy could be also used in the operable, early stage NSCLC.

N93 The value of radical radiotherapy in patients with penile cancer

N93 The value of radical radiotherapy in patients with penile cancer

P3.103. Serial 18F-FDG CT-PET scans during radical radiotherapy inpatients with squamous cell carcinoma of the head and neck

P3.103. Serial 18F-FDG CT-PET scans during radical radiotherapy inpatients with squamous cell carcinoma of the head and neck

2520 POSTER Oral Temozolamide concurrent with radical radiotherapy for patients with glioblastoma multiforme: The University Hospitals of Leicester Experience

2520 POSTER Oral Temozolamide concurrent with radical radiotherapy for patients with glioblastoma multiforme: The University Hospitals of Leicester Experience

Comparison of CT and positron emission tomography/CT coregistered images in planning radical radiotherapy in patients with non‐small‐cell lung cancer

Imaging with F-18 fluorodeoxyglucose positron emission tomography (PET) significantly improves lung cancer staging, especially when PET and CT information are combined. We describe a method for obtaining CT and PET images at separate acquisitions, which allows coregistration and incorporation of PET information into the radiotherapy (RT) planning process for non-small-cell lung cancer. The influence of PET information on RT planning was analysed for 10 consecutive patients. Computed tomography and PET images were acquired with the patient in an immobilization device, in the treatment position. Using specially written software, PET and CT data were coregistered using fiducial markers and imported into our RT planning system (Cadplan version 6). Treatment plans were prepared with and without access to PET/CT coregistered images and then compared. PET influenced the treatment plan in all cases. In three cases, geographic misses (gross tumour outside planning target volume) would have occurred had PET not been used. In a further three cases, better planning target volume marginal coverage was achieved with PET. In four patients, three with atelectasis, there were significant reductions in V20 (percentage of the total lung volume receiving 20 Gy or more). Use of coregistered PET/CT images significantly altered treatment plans in a majority of cases. This method could be used in routine practice at centres without access to a combined PET/CT scanner .

Safety study of induction chemotherapy and synchronous radiotherapy (RT) and cetuximab in stage III non-small cell lung cancer (NSCLC): SCRATCH (Cohort I)

18032 Background: The addition of cetuximab can increase the efficacy of chemotherapy for advanced NSCLC. Concomitant cetuximab and RT is superior to RT alone for locally advanced squamous cell head &amp; neck carcinoma. The SCRATCH study (cohort I) is a phase I study to assess the safety of synchronous cetuximab and radical RT in patients with Stage III NSCLC. Methods: Cohort I will contain 12 patients with inoperable stage III NSCLC. Inclusion criteria are performance status 0–1, adequate organ function, and disease encompassable within a radical RT volume. Exclusion criteria are previous malignancy, thoracic RT or treatment with EGFR targeted therapy. Patients receive platinum-based induction chemotherapy, followed by weekly intravenous cetuximab (initial dose 400mg/m2; maintenance dose 250mg/m2) and concomitant RT (64Gy/32fractions/45days). The primary end-point is toxicity. NCI Common Toxicity Criteria (CTC) V3.0 assessments are performed weekly during radiotherapy, and at regular follow-up visits. Results: Data from the first 9 patients is available. 2 patients stopped receiving cetuximab early due to toxicity. 1 experienced grade 3 fatigue following the initial dose, and the other declined further treatment after developing grade 2 skin toxicity. 2 patients have died, 1 from disease progression and 1 from thromboembolic disease. Both deaths occurred between months 2 and 4 post RT and were not attributed to the cetuximab therapy. Of the 7 living patients, 2 have survived 1 year (measured from the first day of induction chemotherapy). The maximum NCI CTC V3.0 scores are summarised in the table below. Conclusions: The results suggest that the early and late toxicities of synchronous cetuximab and radical RT are acceptable. Data on all 12 patients will be available by June 2007. SCRATCH Study cohorts II-IV follow on and will recruit sequentially. They will assess the safety of adding concomitant cisplatin (±vinorelbine) to cetuximab and radical RT. [Table: see text] No significant financial relationships to disclose.

Carbogen Breathing Combined with Radical Radiotherapy in Advanced Head and Neck Cancer Patients with Severe Co-morbidities

Aims To assess the feasibility of carbogen breathing combined with radical radiotherapy in patients with advanced head and neck cancer who are unfit to receive concomitant chemotherapy. Materials and methods Twenty patients (median age 66 years) with advanced squamous cell carcinoma of the head and neck were treated with either concomitant boost radiotherapy (75%) or mono-fractionated radiotherapy (25%) combined with carbogen breathing. The median tumour dose was 69.5 Gy. The main sites of disease were the oropharynx in 50%, the oral cavity in 15% and the hypopharynx in 30%. All but one patient had stage III (25%) or IV (70%) disease. The median follow-up for the surviving patients was 26 months (range 6–50 months). Results Carbogen breathing was well tolerated, permitting its delivery throughout the radiotherapy course. Three patients had treatment interruption because of acute toxicities (median 15 days; range 3–30 days). Grade 3 Radiation Therapy Oncology Group acute toxicity was observed in 80% of the patients (mainly mucositis), and nutritional support was required in eight patients (40%). Grade 2 late toxicity occurred in 30%; one patient presented with grade 4 late toxicity (bone necrosis). The 2-year actuarial locoregional control for all patients and for those treated with accelerated radiotherapy was 56% and 67%, respectively. The corresponding rates for disease-free survival were 45% and 53%. Conclusions Considering the poor results of radiotherapy alone in advanced head and neck cancer, these results suggest that carbogen breathing may be a valid alternative for patients with severe co-morbidities who are unfit to receive concomitant chemotherapy.

Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation-induced DNA damage in lymphocytes

IntroductionRadiotherapy outcomes might be further improved by a greater understanding of the individual variations in normal tissue reactions that determine tolerance. Most published studies on radiation toxicity have been performed retrospectively. Our prospective study was launched in 1996 to measure the in vitro radiosensitivity of peripheral blood lymphocytes before treatment with radical radiotherapy in patients with breast cancer, and to assess the early and the late radiation skin side effects in the same group of patients. We prospectively recruited consecutive breast cancer patients receiving radiation therapy after breast surgery. To evaluate whether early and late side effects of radiotherapy can be predicted by the assay, a study was conducted of the association between the results of in vitro radiosensitivity tests and acute and late adverse radiation effects.MethodsIntrinsic molecular radiosensitivity was measured by using an initial radiation-induced DNA damage assay on lymphocytes obtained from breast cancer patients before radiotherapy. Acute reactions were assessed in 108 of these patients on the last treatment day. Late morbidity was assessed after 7 years of follow-up in some of these patients. The Radiation Therapy Oncology Group (RTOG) morbidity score system was used for both assessments.ResultsRadiosensitivity values obtained using the in vitro test showed no relation with the acute or late adverse skin reactions observed. There was no evidence of a relation between acute and late normal tissue reactions assessed in the same patients. A positive relation was found between the treatment volume and both early and late side effects.ConclusionAfter radiation treatment, a number of cells containing major changes can have a long survival and disappear very slowly, becoming a chronic focus of immunological system stimulation. This stimulation can produce, in a stochastic manner, late radiation-related adverse effects of varying severity. Further research is warranted to identify the major determinants of normal tissue radiation response to make it possible to individualize treatments and improve the outcome of radiotherapy in cancer patients.

A meta-analysis of randomised trials suggests a survival benefit for combined radiotherapy and radical cystectomy compared with radical radiotherapy for invasive bladder cancer: are these data relevant to modern practice?

Treatment options for muscle-invasive bladder cancer include radical cystectomy or radical radiotherapy, and the prevailing choice varies by country. The ideal treatment would be a bladder-preserving therapy without compromising survival. The objective of this review was to compare the overall survival after radical surgery (cystectomy) with radical radiotherapy in patients with muscle-invasive cancer. We searched the Cochrane Controlled Trials Register, Medline, EMBASE, Cancerlit, Healthstar and the Database of Abstracts of Reviews of Effectiveness. Authors of unpublished data were contacted. Randomised trials comparing surgery (alone or with preoperative radiotherapy) with radiotherapy were eligible for assessment. Three reviewers assessed trial quality based on the Cochrane Guidelines. Data were extracted from the text of the article or extrapolated from the Kaplan-Meier plot. The Peto odds ratio was determined to compare the overall survival and disease-specific survival. Analysis was performed on an intention-to-treat basis and treatment actually received. No randomised trials comparing surgery alone with radiotherapy alone were identified. Three randomised trials comparing preoperative radiotherapy followed by radical cystectomy (surgery) versus radical radiotherapy with salvage cystectomy (radical radiotherapy) were eligible for assessment. These trials represented a total of 439 patients, 221 randomised to surgery and 218 to radical radiotherapy. Three trials were combined for the overall survival results, and one was evaluable for the disease-specific survival analysis. The mean overall survival (intention-to-treat analysis) at 3 and 5 years were 45% and 36% for surgery, and 28% and 20% for radiotherapy, respectively. Peto odds ratio (95% confidence interval [CI]) analysis consistently favoured surgery in terms of overall survival. The results were significantly in favour of surgery at 3 years (OR = 1.91, 95% CI 1.30-2.82) and at 5 years (OR = 1.85, 95% CI 1.22 -2.82). On a treatment-received basis, the results were significantly in favour of surgery at 3 years (OR 1.84, 95% CI 1.17-2.90) and 5 years (OR 2.17, 95% CI 1.39-3.38) for overall survival, and at 3 years (OR 1.96, 95% CI 1.06-3.65) for disease-specific survival. The analysis of this review suggests that there is an overall survival benefit with combined preoperative radiotherapy plus radical surgery compared with radical radiotherapy plus salvage cystectomy in patients with muscle-invasive bladder cancer. However, it must be considered that only three trials were included for analysis, the patient numbers were small and that many patients did not receive the treatment they were randomised to. It must also be noted that many improvements in radiotherapy and surgery have taken place since the initiation of these trials; therefore, the data may not be readily extrapolated to modern practice. Ideally, a new trial comparing modern bladder-sparing therapy with the latest surgical approach to this disease is required.

Outcome of radical radiotherapy for invasive bladder cancer

Purpose/Objective: To review our experience with radical radiotherapy for patients with invasive bladder cancer and to identify predictive factors associated with bladder preservation, risk of relapse and survival.

O-54 Chemotherapy and radical radiotherapy for patients with inoperable NSCLC aged 70 or over — Results of a treatment policy based on performance status and stage at presentation

O-54 Chemotherapy and radical radiotherapy for patients with inoperable NSCLC aged 70 or over — Results of a treatment policy based on performance status and stage at presentation