801P - Comparison between standard and reduced volume radiotherapy in bladder preservation trimodality protocol for muscle invasive bladder cancer patient

Abstract

Invasive bladder cancer is the most common tumor in Egypt. Preservation protocol consists of transurethral resection followed by concomitant chemo/ radiotherapy. The induction part of Radiotherapy is usually delivered to the whole pelvis, The role of omitting pelvic nodal irradiation has not been addressed before.

Aim

To compare the toxicity, pelvic nodal relapse and overall survival of whole bladder irradiation only to standard technique of whole pelvis irradiation followed by bladder boost in patients with muscle invasive bladder carcinoma undergoing bladder preservation protocol.

Material and method

A total of 63 patients with transitional cell carcinoma, stage T2-3,N0,M0 bladder cancer were subjected to maximal TURB. Then, patients randomized into two groups: group I (32 patients) to receive whole pelvis radiotherapy 44Gy followed by 20 Gy bladder boost. While Group II (31 patients) were randomized to receive whole bladder radiotherapy alone for a total dose of 64 Gy. In both groups, concomittant cisplatin and paclitaxel were given weekly throughout the whole course of radiotherapy where conventional 2 Gy/ fraction were used. additionally, 4 cycles of Adjuvant cisplatin and paclitaxel were given after the end of chemo radiotherapy induction course.

Results

Three patients, two in group I and one in group II discontinued due to grade 3 toxicity. After a median follow up of 2 years, regional relapse occurred in 7.1% of patients in group I and 10.3% in group II. (p = 1). Distant metastases were detected in 17.9% of patient in group 1 and 13.8% in group II.(p = 0.73). The 2-year disease free survival was 60% in group I and 63.3% in group II (p = 0.79). The whole 2-years overall survival was 75% in group I and 79.3% in group II (p = 0.689). Radiation gastrointestinal (GI) Acute toxicity was higher in group I than in group II (p = 0.001), while late GI radiation toxicity was comparable in both groups.

Conclusion

treating the bladder only without elective pelvic nodal irradiation, did not compromise pelvic control rate, but significantly decreased the acute radiation toxicity.

Disclosure

All authors have declared no conflicts of interest.