ABSTRACT
Objective To evaluate the impact of preoperative accelerated hyperfractionated radiotherapy in the management of bladder carcinoma in Egyptian patients. Patients and Methods Between December 1996 and February 2000; 104 Egyptian patients with pathologically proven infiltrative bladder carcinoma were enrolled in this prospective study. Patients with all pathological subtypes; non-metastatic disease; clinical stage T2-T4; and medically operable were eligible for this study. A total preoperative dose of 45 Gy was given in an overall time of 3 weeks; 1.5 Gy/fraction; 2 fractions/day with an interval of 6 hours in between; 5 days/week. Three weeks later; this was followed by radical cystectomy with pelvic node dissection. The clinical radiation response of the tumor was evaluated by C.T. scan done before irradiation and just before surgery. Only 56 patients completed this treatment program. The median follow-up was 26 months; ranging from 9 to 32 months. Results The actuarial 2-year disease-free survival (DFS) of the 56 patients was 63.9; with 50of failures due to pelvic recurrences. The univariate analysis revealed that only lymph node infiltration and pathological staging correlated significantly with DFS. There was a marginal insignificant improvement of DFS among patients who showed an increased tumor regression after radiotherapy. The multivariate analysis using the Cox model showed that lymph node affection is the only significant predictor for DFS. Other factors including age; sex; cell type; bilharzial infestation and clinical radiation response did not show a significant importance regarding the DFS. Minimal acute radiation toxicity with no late tissue reaction was observed among the whole group of patients. No increased operative difficulty related to irradiation nor an increased postoperative morbidity was found. Conclusion The potential biological advantage of this preoperative radiation schedule (in terms of a shorter overall duration of treatment; a shorter preoperative treatment period; a lower dose per fraction and an overall dose equivalent to conventional fractionation); aiming at an increased tumor regression and a decrease of late normal tissue reaction with its impact on DFS; remains to be further investigated with a larger number of patients and a longer follow-up