title: Muscle-invasive bladder cancer treated with TURB followed by concomitant boost with small reduction of radiotherapy field with or without of chemotherapy.
abstract: OBJECTIVE
  To evaluate the clinical outcome and toxicity of the treatment of muscle-invasive bladder cancer (MIBC) that combined transurethral resection of bladder tumor (TURB) with "concomitant boost" radiotherapy delivered over a shortened overall treatment time of 5 weeks, with or without concurrent chemotherapy.
  
  
  BACKGROUND
  Local control of MIBC by bladder-sparing approach is unsatisfactory. In order to improve the effectiveness of radiotherapy, we have designed a protocol that combines TURB with a non-conventionally fractionated radiotherapy "concomitant boost".
  
  
  METHODS
  Between 2004 and 2010, 73 patients with MIBC cT2-4aN0M0, were treated with "concomitant boost" radiotherapy. The whole bladder with a 2-3 cm margin was irradiated with fractions of 1.8 Gy to a dose of 45 Gy, with a "concomitant boost" to the bladder with 1-1.5 cm margin, during the last two weeks of treatment, as a second fraction of 1.5 Gy, to a total dose of 60 Gy. Radiochemotherapy using mostly cisplatin was delivered in 42/73(58%) patients, 31/73(42%) patients received radiotherapy alone.
  
  
  RESULTS
  Acute genitourinary toxicity of G3 was scored in 3/73(4%) patients. Late gastrointestinal toxicity higher than G2 and genitourinary higher than G3 were not reported. Complete remission was achieved in 48/73(66%), partial remission in 17/73(23%), and stabilization disease in 8/73(11%) patients. Three- and five-year overall, disease specific and invasive locoregional disease-free survival rates were 65% and 52%, 70% and 59%, 52% and 43%, respectively.
  
  
  CONCLUSIONS
  An organ-sparing approach using TURB followed by radio(chemo)therapy with "concomitant boost" in patients with MIBC allows to obtain long-term survival with acceptable toxicity.
authors.affiliation: Oncology Clinic, Gastrointestinal and Urological Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Nowak-Sadzikowska
authors.affiliation: Oncology Clinic, Gastrointestinal and Urological Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Skóra
authors.affiliation: Oncology Clinic, Gastrointestinal and Urological Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland.
authors.forename: Bogumiła
authors.initials: B
authors.lastname: Szyszka-Charewicz
authors.affiliation: Oncology Clinic, Gastrointestinal and Urological Cancer Unit, Centre of Oncology, Maria Skłodowska-Curie Memorial Institute, Cracow Branch, Kraków, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jakubowicz
keywords: Concomitant boost; Muscle-invasive bladder cancer; Radical conservative treatment; Radiotherapy