PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s): The optimal schedule for palliative external beam radiotherapy (EBRT) in bladder tumors with hematuria unfit for surgery remains to be defined. The aim of this study was to assess short and mid-term clinical hemostatic efficacy and safety of two EBRT hypofractionated schedules.
Materials/Methods: From February 2008 to October 2017, 31 patients (pts) were referred to our department for palliative hemostatic irradiation. EBRT consisted mainly of two schedules: “continuous” treatment was delivered following consecutive 3-10 days (3-6Gy/fraction (fr), to a total dose of 18-30Gy) (group 1, n=14); alternatively, “discontinuous” schedule consisted of 23Gy in 4fr (6.5Gy/fr, days 1 and 3, followed by 5Gy/fr, days 15 and 17; group 2, n=12). Group 2 pts were assessed on d15 before the second EBRT sequence to evaluate hemostatic control (HC) and general conditions. In both groups, the target volumes encompassed the bladder with a margin. The primary endpoint was the rate of HC at the end of the radiation course and at the last follow-up. Other endpoints included toxicities and overall survival. Comparative analyses were performed by exact Fisher test with a cut-off of 0.05 for statistical significance.
Results: Twenty-six of 31 pts were eligible for efficacy and safety analyses. Median age was 78 (38-99) years with a predominance of males (n=22; 84%). Eastern Cooperative Oncology Group performance status was 0-1 in nine (35%) pts and 2-4 in 27 (65%) pts. Rate of HC at the end of EBRT was 92% (n=24) with no significant differences between group 1 (100%) vs group 2 (86%; p=0.48). With a median follow-up of six months, HC was achieved in 15/26 (58%) pts at the last follow-up, without meaningful differences between group 1 (50%) and group 2 (67%; p=0.45). When excluding the three pts who received 30Gy in 10fr from the analysis, there is still no significant difference in HC at the end of EBRT (100% vs 86%) and at the last follow up (70% vs 67%) between the groups. Three of 12 pts from group 2 achieved complete HC at the end of the 1st EBRT sequence delivering 13Gy in 2fr on d1 and d3). Only three and two pts developed acute grade <2 diarrhea in groups 1 and 2, respectively. Median survival was six months in the whole population. Only three (11%) pts were still alive at two years.
Conclusion: Our study suggests that both “continuous” and “discontinuous” schedules of hypofractionated EBRT, are well tolerated and achieve excellent short term HC without any difference between the two groups. In the “discontinuous” schedule that may require an organizational effort, the large majority of the pts needed both sequences at d1-d3 and d15-17. Prospective trials are needed to define the best schedule of EBRT in the era of new technologies.
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