title: [When should the primary tumor of metastatic bladder or prostate cancer be treated using a nonsurgical regimen?]
abstract: BACKGROUND
  Patients with metastatic and locally advanced bladder or prostate cancer may suffer from pelvic symptoms such as pain, obstruction, and hemorrhage. Local tumor growth is associated with significant morbidity and systemic therapy is often ineffective. Local therapies such as bladder irrigation, transurethral resection of the prostate, and fulguration of bleeding vessels provide relief but often require repeated treatments.
  
  
  OBJECTIVE
  The aim of this work was to review the current status of palliative pelvic radiotherapy for metastatic bladder and prostate cancer.
  
  
  METHODS
  The available literature was evaluated and treatment recommendations are proposed depending on different clinical scenarios.
  
  
  RESULTS
  To date, no standard regimen exists for the delivery of palliative pelvic radiotherapy. Various radiotherapy schedules manage successful and long-term palliation of pelvic symptoms in most patients and result in acceptable toxicity. For bladder cancer, the most common dose and fractionation regimens range from 20 Gy in 5 fractions to 40 Gy in 20 fractions. Some retrospective studies evaluated 6 weekly fractions of 6 Gy to a total dose of 36 Gy. For prostate cancer, the most common dose and fractionation regimes range from 30 Gy in 10 fractions to 50 Gy in 25 fractions. The symptomatic response rate is between 70 and 95%.
  
  
  CONCLUSIONS
  Pelvic radiotherapy for patients with metastatic and locally advanced bladder or prostate cancer provides effective and long-term palliation of a variety of symptoms such as pain, obstruction, and hemorrhage, with acceptable toxicity. Future studies should investigate the optimal target dose and fractionation schedule.
authors.affiliation: Fachbereich Strahlentherapie und Radioonkologie, MVZ Klinikum Esslingen GmbH, Hirschlandstraße 97, 73730, Esslingen a. N., Deutschland. d.bottke@mvz-ke.de.
authors.forename: D
authors.initials: D
authors.lastname: Bottke
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Bolenz
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Ott
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Cebulla
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Ulm, Albert-Einstein-Straße 23, 89081, Ulm, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Wiegel
mesh_terms: D059248:Chemoradiotherapy / Q000401:mortality / Q000706:statistics & numerical data*; D015653:Cystectomy / Q000401:mortality / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D015995:Prevalence; D011468:Prostatectomy / Q000401:mortality / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery / Q000401:mortality / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
keywords: Dose hypofractionation; Hematuria; Palliative medicine; Radiochemotherapy; Radiotherapy, intensity-modulated