Palliative radiotherapy in bladder cancer - importance of patient selection: a retrospective multicenter study

Abstract

OBJECTIVE: Investigate the effectiveness of palliative pelvic radiotherapy (PRT) in bladder cancer patients and identify factors associated with treatment outcome. MATERIAL AND METHODS: Patients with bladder cancer receiving PRT were identified retrospectively from two cancer centres between 2014 and 2017. Patients were stratified by age, stage, performance status, co-morbidities, previous chemotherapy, previous radiotherapy and radiotherapy protocol. Patients were followed up at 6 weeks after RT Median overall survival (mOS) from the last fraction of RT was calculated. Death within 30-days of RT or non-completion of treatment were considered as futile treatment. RESULTS: 241 patients were identified as receiving PRT A variety of RT protocols were used: 8Gy/1 fraction (11%), 21Gy/3 fractions (15%), 20Gy/5 fractions (18%), 36Gy/6 fractions (36%), 27.5-30Gy/8-10 fractions (18%). 38% of patients were of poor performance status (ECOG PS >/=3) and 46.5% had significant co-morbidities (ACE-27 >/=2). The mOS from the last fraction of RT was 153 days (0-1289 days). The 30-day mortality after radiotherapy was 18% (n=44) and incomplete planned radiotherapy treatment was 14% (n=33). First follow up information was available in 62% (n=150) of patients. Median time to this follow-up was 49 days (14-238 days). At first follow up about 6 weeks of last fraction of radiotherapy, patient symptoms were reported in 150 of 200 (75%) alive patients where 80 of 150 (53%) patients reported improvement in symptoms after treatment. There were significant differences in mOS with stage, performance status and co-morbidities. CONCLUSION: One in four patients either did not complete the planned RT course and/or died within 30 days of treatment. These patients were unlikely to have received maximal benefit from treatment but may have experienced side effects, making treatment futile. Patients with good performance status and earlier stage disease survived longer. Patient selection and comprehensive assessment are crucial in selecting appropriate patients for treatment.