Concomitant boost radiotherapy plus concurrent cisplatin for muscle invasive bladder cancer

ABSTRACT

To determine the efficacy and toxicity of accelerated concomitant boost radiotherapy [RT] plus concurrent cisplatin in patients with muscle invasive bladder cancer. Sixty four patients with muscle invading transitional cell bladder cancer were entered into a protocol of transurethral resection of the bladder tumor [TURBT] followed by concurrent cisplatin [10mg/m[2] thrice weekly] and accelerated concomitant boost radiotherapy. The whole pelvis was treated by l.8Gy conventional daily fractions up to a total dose of 45Gy. A concomitant boost limited to the bladder was delivered as a second daily fraction [1.4Gy] during the last 3 weeks up to a total dose of 66Gy. The patients were evaluated for local control, toxicity and survival. All but two patients completed the radiotherapy protocol. Fifty eight patients received the full doses of cisplatin. Grade 3 acute urinary toxicity was observed in 10 patients [15.6%]. Also, 6 patients [9.4%] presented with acute grade 3 bowel toxicity. Eight patients [12.6%] experienced late grade 3 toxicity [4 with bladder and 4 with bowel toxicity]. The 3-year actuarial local control, distant disease control and overall survival rates were 60% [95% CI, 50.1-69.3], 65.6% [95% CI, 53.7%-74.3%], and 37.5% [95% CI, 26.1%-45.9%] respectively. The results of our protocol of acclerated concomitant boost radiotherapy with concurrent cisplatin, as regard locoregional control and overall survival, did not appear to be improved in comparison with other studies combining cisplatin and standard conventional fractionation, moreover the observed toxicity was higher