Medical Radiology and Radiation Safety. 2014. Vol. 59. No. 2. P. 39-46

RADIATION THERAPY

Yu.V. Gumenetskaya, Yu.S. Mardynsky, I.A. Gulidov, O.B. Karyakin

Results of a Comparative Analysis of the Effectiveness of Different Methods of Palliative Radiation Therapy for Bladder Cancer

Medical Radiological Research Center, Kaluga Region, Obninsk. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Purpose: To analyze the results of palliative radiation therapy for bladder cancer and to assess the effects of dose-fractionation regimens on treatment effectiveness.

Material and methods: The immediate and long-term results of palliative radiation therapy in 90 bladder cancer patients who had been treated in the Medical Radiological Research Center within the period from1990 to 2010 were analyzed. Three dose-fractionation regimens were used:

1) Conventional fractionation (CF; single tumor dose 2 Gy, total tumor dose 40–46 Gy; n = 37);

2) Hypofractionation (HF; single tumor dose 3 Gy, total tumor dose 30 Gy, n = 22);

3) Accelerated dynamic dose-fractionation (ADDF; total tumor dose 30 Gy, n = 31).

Results: Palliative radiation therapy could stop and reduce hematuria in 73.1 % and 26.9 % of cases, respectively; alleviate bladder pain syndrome in 75.0 % of cases; achieve objective tumor response to therapy after 6 months and 12 months in 34.4 % and 31.1 % of cases, respectively. Median survival after the palliative treatment was 12.9 ± 1.3 months. After accelerated dynamic fractionation, hematuria was stopped in 91.7 % of cases versus 63.0 % after conventional fractionation (p < 0.05) and 62.5 % of cases after hypofractionation; objective tumor response (6 months after therapy) was achieved in 48.4 % of cases versus 24.3 % after CF (p < 0.05) and 31.8 % of cases after HF. Late bladder complications of grades 1–2 (RTOG/EORTC) were seen in 9.7 % of cases in ADDF group versus 18.2 % in HF group and 18.9 % of cases in CF group (p < 0.2). No complications of grade ≥ 3 occurred. Median survival in CF group was 12.0 ± 1.6 months, in HF group – 12.3 ± 4.4 months, and in ADF group – 14.3 ± 8.5 months.

Conclusion: Radiation therapy is an effective palliative treatment in patients with contraindications for surgical and anti-tumor drug therapy of complications of bladder cancer. Accelerated dynamic dose-fractionation allowed to improve the effectiveness of palliative treatment in bladder cancer patients and to reduce treatment times without complications increasing.

Key words: bladder cancer, palliative radiation therapy, fractionation regimen