title: Radical radiotherapy with salvage surgery for invasive bladder cancer: results following a reduction in radiation dose.
abstract: 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.
authors.affiliation: Department of Clinical Oncology, Western General Hospital, Edinburgh, UK.
authors.forename: D
authors.initials: D
authors.lastname: Whillis
authors.forename: G C
authors.initials: GC
authors.lastname: Howard
authors.forename: G R
authors.initials: GR
authors.lastname: Kerr
authors.forename: J
authors.initials: J
authors.lastname: Fowler
authors.forename: T B
authors.initials: TB
authors.lastname: Hargreave
authors.forename: G D
authors.initials: GD
authors.lastname: Chisholm
mesh_terms: 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*