Radical radiotherapy with salvage surgery for invasive bladder cancer: results following a reduction in radiation dose.
The management of invasive bladder cancer in Edinburgh, as in many other centres in the UK, has been by radical radiotherapy, with cystectomy reserved for local treatment failure or relapse. A review of the results of this policy in 1987 highlighted what was felt to be an unacceptably severe morbidity rate of 15%. The dose of radiation was therefore reduced from 55 Gy in 20 daily fractions to 52.5 Gy. Forty of 80 patients (50%) treated in this way have achieved a complete response at 6 months which is a similar response rate to that in previous reports. In addition, ten of 23 frail or elderly patients (43%) achieved a complete response with a lower dose of 50 Gy given as a split course over 7 weeks. Eighteen patients have had a salvage cystectomy, and 12 of 18 (67%) are alive and disease-free. Although follow-up is short, to date toxicity has been reduced, and our results support our decision to reduce the radiation dose.
Whillis
D
D
Department of Clinical Oncology, Western General Hospital, Edinburgh, UK.
Howard
G C
GC
Kerr
G R
GR
Fowler
J
J
Hargreave
T B
TB
Chisholm
G D
GD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects / Q000592:standards*; D016879:Salvage Therapy / Q000592:standards; D012606:Scotland / Q000453:epidemiology; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*