A comparison of two radiotherapy regimens for the treatment of symptoms from advanced bladder cancer.

Pain and haematuria are two of the most distressing symptoms in patients with advanced bladder cancer. The aim of palliative radiotherapy is to relieve these symptoms with the minimum of stress to the patient and with minimal side effects. Two treatment regimens were studied: hypofractionated radiotherapy giving 1700 cGy in two fractions over 3 days and conventional palliative radiotherapy giving 4500 cGy in 12 fractions over 26 days. This study assesses 41 patients, all with Grade II-III T3-4 transitional cell carcinomas of the bladder treated between 1982 and 1989, presenting with haematuria and local pain. Two-fraction (hypofractionated) treatment was given to 22 patients and conventional palliative radiotherapy to 19; patients were selected by performance status. The effect on haematuria was assessed as cleared, intermittent or persistent. Pain was assessed by noting reduction in the need for opiate analgesia. Any side effect was recorded. In the patients receiving two-fraction radiotherapy, 59% had clearance of the haematuria and in 73% there was improvement of their pain, compared with 16% and 37% respectively in those receiving conventional palliation. Survival of the two groups was 9.77 months and 14.47 months respectively. Side effects were trivial in both regimens. Radiotherapy given in two fractions for patients in poor general health is well tolerated and less distressing than the standard palliative regimen with 12 fractions. Haematuria and pain were more effectively palliated than with conventional treatment, though survival was shorter. We conclude that hypofractionated radiotherapy may be the palliative treatment of choice and the study supports the need for a prospective assessment of this treatment approach.