title: A pilot study of accelerated fractionation in the radiotherapy of invasive carcinoma of the bladder.
abstract: 24 patients with muscle invasive carcinoma of the bladder were treated in a pilot study of twice daily fractionation at radiation doses of 1.8-2.0 Gy per fraction to total doses of 54-64 Gy to the bladder and 39.6-44 Gy to the whole pelvis. The treatment aim was to give 32 fractions in 22 days. The interfraction interval was a minimum of 6 h. The principle objective was to record acute and late tolerance, but local control and survival data is also presented. Acute radiation morbidity was scored according to the RTOG system. Grade 2 large bowel effects were seen in 52% of patients, Grade 3 effects in 26% and there was one Grade 4 and one Grade 5 effect. The mean duration of effect was 4.5 weeks although the more severe reactions were also more protracted. Grade 2 urinary effects occurred in 30% and Grade 3 in 17% of patients. The mean duration of effect was 7.2 weeks. There were no Grade 4 or 5 acute urinary effects. Late radiation morbidity was scored according to the EORTC/RTOG system and was assessable in 16 cases who survived more than 6 months. There were two cases (12%) of Grade 1 bowel toxicity, two cases of Grade 1 and three of Grade 2 urinary toxicity. There were no cases of late skin effects. Actuarial analysis at 2 years shows a local control probability of 56% and survival probability of 35%.
authors.affiliation: Department of Radiotherapy and Oncology, Churchill Hospital, Oxford, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cole
authors.forename: K R
authors.initials: KR
authors.lastname: Durrant
authors.forename: J T
authors.initials: JT
authors.lastname: Roberts
authors.forename: P J
authors.initials: PJ
authors.lastname: Dawes
authors.forename: H
authors.initials: H
authors.lastname: Yosef
authors.forename: J W
authors.initials: JW
authors.lastname: Hopewell
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007420:Intestine, Large / Q000528:radiation effects; D007421:Intestine, Small / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011832:Radiation Injuries / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D012867:Skin / Q000528:radiation effects; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy*; D014566:Urogenital System / Q000528:radiation effects