Hypofractionated radiotherapy for muscle invasive bladder cancer in the elderly

Background and purpose: We have retrospectively investigated a hypofractionated regimen in a cohort of 65 elderly patients (median age 78 years), designed to minimize acute radiation affects and maximize patient tolerance and convenience in this frail group. Materials and methods: All patients were CT planned to a small volume. Once weekly fractions (6 Gy) prescribed to the 100% isodose as a target minimum to 30 Gy (n = 53) and 36 Gy (n = 12) were administered. Palliation of symptoms before, during, and 1 month from completion of radiotherapy were graded using the urinary and bowel symptom and toxicity index. Results: Fifty-five patients had persisting urinary symptoms following trans urethral resection of bladder. Twenty-eight (51%) were completely palliated of symptoms and 7 (13%) noticed an improvement at a 1 month review. Ninety-two percent of patients with haematuria were completely palliated compared to only 24% of those with dysuria and frequency. The median symptom free interval was 7 months (range 2-40 months). Median overall survival was 9 months (range 2-41 months). Twelve percent of patients required inpatient admission and only three failed to complete the prescribed course due to bowel toxicity. Grade 3 acute urinary and bowel treatment related toxicity, were recorded in 18% and 9% of patients, respectively. In total, 43% of patients noticed a transient worsening of their presenting symptoms on treatment. To date no significant late toxicity (>grade 2) has been recorded. Conclusions: This regimen is generally well tolerated and offers reasonable palliation of symptoms on an outpatient basis for this frail poor prognosis group. Haematuria is particularly well palliated although only a quarter of patients presenting with dysuria and frequency were rendered symptom free.