PHASE II TRIAL OF HYPOFRACTIONATED EXTERNAL-BEAM RADIOTHERAPY FOR MACROSCOPIC HEMATURIA IN ADVANCED URINARY BLADDER CANCER

External-Beam Radiotherapy in Urinary Bladder Cancer

Abstract

Objective: The objective of this study was to determine the efficacy of hypofractionated external-beam radiotherapy for management of macroscopic hematuria in patients with advanced urinary bladder cancer.
Study Design: Quasi-experimental study.
Place and Duration of Study: This study was conducted from December 2014 to May 2015, at the department of oncology Combined Military Hospital Rawalpindi.
Material and Methods: Forty patients with macroscopic hematuria grade 2, 3 or 4 associated with advanced stage (III / IV) urothelial urinary bladder cancer unfit for curative treatment, were enrolled. All patients were subjected to hypofractionated radiotherapy (21gray/3fractions). We used Common Toxicity Criteria Adverse Event (CTCAE) Version 4.0 (Hematuria) for grading of macroscopic hematuria before radiotherapy and at day 15 after radiotherapy. Two proformas were designed to get clinical information and grade of hematuria.
Results: Thirty four male and 06 female patients of advanced urinary bladder cancer with macroscopic / gross hematuria were included. Mean age was 60.22 ± 5.72 years. Out of these (n=40) 21 patients (52.5%) presented with grade 3, 17 patients (42.5%) presented with grade 4 while 2 patients (5%) presented with grade 2 hematuria. All patients received hypofractionated radiotherapy (21gray/3fractions). Of these (n=40) 27 patients (67.5%) were hematuria free with complete cessation of bleeding, 10 patients (25%) had ≥1 Grade improvement in gross hematuria) while 3 patients (7.5%) had no improvement in macroscopic hematuria on CTCAE) Version 4.0 (Hematuria).
Conclusion: Hypofractionated radiotherapy (21Gray/3Fractions) is an effective treatment modality for palliation of macroscopic / gross hematuria in advanced urinary bladder cancer patients.