title: Long-term outcomes in treatment of invasive bladder cancer with concomitant boost and accelerated hyperfractionated radiation therapy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term clinical efficacy and toxicity of concomitant boost and accelerated hyperfractionated radiation therapy (CBAHRT) in patients with invasive bladder cancer.
  
  
  METHODS
  Between October 1997 and September 2012, 334 patients with diagnoses of invasive bladder cancer were selected. These patients received CBAHRT as a bladder-conserving approach. The treatment consisted of a dose of 45 Gy/1.8 Gy to the whole pelvis with a daily concomitant boost of 1.5 Gy to the tumor. Total dose was 67.5 Gy in 5 weeks. A total of 32 patients (10.3%) had a diagnosis of stage T1, 202 (64.3%) were at stage T2, 46 (14.6%) were at stage T3a, 22 (7%) were at stage T3b, and 12 (3.8%) were at stage T4a.
  
  
  RESULTS
  The follow-up period was 33.1 months (range, 4.3-223.3 months). Grade 3 late intestinal toxicity was observed in 9 patients (2.9%), whereas grade 3 late urinary toxicity was observed in 8 patients (2.5%). The median overall survival (OS) was 26.3 months (95% confidence interval [CI]: 21.4-31.2). The 5-, 10, and 15-year OS rates were 32.1% (standard error [SE], ± 0.027), 17.9% (SE, ± 0.025) and 12.5% (SE, ± 0.028), respectively. The median cause-specific survival (CSS) was 42.1 months (95% CI: 28.7-55.5). The 5-, 10-, and 15-year CSS rates were 43.2% (SE, ± 0.03), 30.3% (SE, ± 0.03), and 28% (SE, ± 0.04), respectively. The median relapse-free survival (RFS) was 111.8 months (95% CI: 99.6-124). The 5-, 10-, and 15-year RFS rates were 61.9% (SE, ± 0.03), 57.6% (SE, ± 0.04), and 48.2% (SE, ± 0.07), respectively.
  
  
  CONCLUSIONS
  The CBAHRT technique demonstrated acceptable toxicity and local control rates in patients with invasive bladder cancer, and this therapy facilitated bladder conservation. In selected patients, the CBAHRT technique is a practical alternative treatment option with acceptable 5-, 10-, and 15-year results in patients undergoing cystectomy as well as concurrent chemoradiation therapy.
authors.affiliation: Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey. Electronic address: dremocan@yahoo.com.
authors.forename: Emine
authors.initials: E
authors.lastname: Canyilmaz
authors.affiliation: Department of Radiation Oncology, Akdeniz University, Antalya, Turkey.
authors.forename: Melek Nur
authors.initials: MN
authors.lastname: Yavuz
authors.affiliation: Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Lasif
authors.initials: L
authors.lastname: Serdar
authors.affiliation: Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey.
authors.forename: Gonca Hanedan
authors.initials: GH
authors.lastname: Uslu
authors.affiliation: Department of Radiation Oncology, Kanuni Research and Education Hospital, Trabzon, Turkey.
authors.forename: Ahmet Yasar
authors.initials: AY
authors.lastname: Zengin
authors.affiliation: Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Aynaci
authors.affiliation: Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Haciislamoglu
authors.affiliation: Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Zumrut
authors.initials: Z
authors.lastname: Bahat
authors.affiliation: Department of Radiation Oncology, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Yoney
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods; D011832:Radiation Injuries / Q000150:complications; D012189:Retrospective Studies; D047368:Tumor Burden; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*