SALVAGE RADIOTHERAPY IN MUSCLE-INVASIVE BLADDER CANCER: EXPERIENCE OF THE S. GIOVANNI CALIBITA FATEBENEFRATELLI HOSPITAL IN ROME

Aim: The object of this study was to report on the use and results of salvage radiotherapy, in terms of overall survival (OS) and disease free survival (DFS), in the treatment of muscle-invasive bladder cancer, at the Department of Radiotherapy, Ospedale San Giovanni Calibita Fatebenefratelli in Rome. Patients and Methods: From January 2006 to September 26 patients (18 men and 8 women) with muscle invasive bladder cancer, who had previously been treated surgically, underwent salvage radiation therapy; 21 of those patients underwent transurethral endoscopic resection and 5 of them underwent radical cystectomy. The median age was 75 (range 49-90) years. Up until 2007, patients were treated with 3D conformational technique and from 2008 until the time of writing, with intensity-modulated radiation therapy (IMRT). Treatment volumes included pelvis and bladder in 18 patients, with total doses of 45-50 Gy prescribed to the pelvic nodes and up to 60-70 Gy to the bladder or bladder bed, with single daily fractions of 1.8-2 Gy. In eight patients, the treatment was directed only to the bladder, with doses of 60 Gy in two patients, of 66 Gy in two patients and of 70 Gy in four patients. Five patients received concomitant chemotherapy, based on cisplatin with or without gemcitabine. Results: The median follow-up was 14 (range 6-39) months. Radiation therapy-related toxicity was acceptable with G3-G4 acute toxicity of the gastrointestinal tract (GIT) in 10% of patients and G3-G4 acute toxicity of the genitourinary tract (GUT) in 15% patients. Late toxicity of the GIT two years after completing radiotherapy was absent, and was G4 in 2% patients in the GUT. The median OS and DFS were 19 and 18 (range 1-39) months, respectively. At the time of writing, 54% of the patients were alive and 71% were without clinical evidence of disease. Over 80% of the patients who previously underwent bladder-sparing therapy retained bladder function. Discussion and Conclusion: Our data suggest a clear benefit from salvage radiotherapy in terms of OS and DFS, allowing more than 80% of patients, alive without disease progression, to retain bladder function.