$460 Posters

Conclusion: Even after fluid deprivation, bladder volume change resulted in wall displacement of up to 42mm over 28 minutes. Intrafraction bladder motion may compromise accurate treatment delivery, especially after fluid consumption and should be considered when planning conventional or adaptive RT, or IMRT, to the bladder. The asymmetrical pattern and variations between patients support individualisation of margins; the reproducibility of these findings suggest they might be extrapolated to interfraction motion. On-treatment X-ray volumetric (cone-beam) imaging allows acquisition of 3D images immediately before and after treatment to assess and account for bladder motion.

1095 poster

The possibility of developing a bladder conservation protocol for squamous cell (SQC) bladder cancer

H. Awwad National Cancer Institute, Radiotherapy, Cairo, Egypt

Purpose: In Egypt about 50% of bladder cancer cases are of the less radiosensitive SQC type in association with schistosomal infection (lowered radiotolerance). Radical cystectomy is therefore still the treatment of choice. Recently, however, the incidence and severity of schistosomal infection has markedly diminished. Radiotherapy techniques that permit safe delivery of high radiation doses have also been developed. Chemotherapeutic agents active against both SQC and transitional cell cancer (TCC) have also been tested. This motivated a phase II study testing the possibility of applying a bladder conservation protocol in patients with either SQC or TCC who are medically unfit for radical cystectomy.

Methods: 72 patients-with T2b-4a, NO (or Nx), M0 bladder cancer (SQC: 31, TCC:41 ) who were technically operable but medically unfit for cystectomy were included. After attempting TUR, 50.6 Gy of hyperfractionated radiotherapy (44 fractions, 2F/day, 1.15 Gy each, 5 treatment days/week) is given along with weekly concomitant platinol (30 mg/m 2) plus gemcitabine (250 mg/m2). A daily dose of the Cox-2 inhibitor (Celebrex) along with acetyl salicylic acid (1 g bid) were given. Response evaluation is then performed including cystoscopy and CT. This is followed by a boost dose of 20.7 Gy in 18 fractions along with weekly platinol and gemcitabine. The expression of Rb, p53, Ras, urolplakin III and CK 18 were determined in histological tumour sections using immunohistochemistry.

Results: Compliance amounted to 68/72 (94%) with neutropaenia in 65%, anaemia in 40% and thrombocytopaenia in 25%. Some degree of acute cystitis and proctitis were experienced by all patients with G1 late bladder and rectal toxicity in 79% of patients. CR at 6 months amounted to 54%. Disease free survival at 2 years amounted to 52?11% in TCC and 43?15% in SQC (p<0.05). Correlation between markers and clinical results will be presented.

Conclusions: Application of bladder conservation protocol in SQC is worth continuing. The possibility of predicting the radiation response on the basis of biological markers has to be continued. At a later date, stage phase III study can be considered in patients technically and medically fit for surgery provided that cystectomy is performed after the induction phase in case of failure to achieve CR.

1096 poster

Conservative treatment of invasive bladder cancer by radiochemotherapy. Long term results

1 2 G. Arcangefi , D. Tirindelli Danesi , E. Cruciam ~, B. 1 2 Saracino , P. Altavista

I Regina Elena Cancer Institute, Radiation Oncology, Rome, Italy 2ENEA, Toxicology and Biomedical Sciences, Rome, Italy 3Fatebenefratelli S. Giovanni Cafibita Hospital, Urology, Rome, Italy

Organ preservation has been investigated in muscle-invasive bladder cancer over the past decades as an alternative to radical cystectomy. The results of the large majority of studies suggest that trimodal schedules, including transurethral resection of bladder tumor, radiotherapy and chemotherapy, are a feasible and safe organ-sparing approach without deferring the survival probability. However the best combination of radiotherapy and chemotherapy is not yet well defined. This study was aimed at evaluating long term results of a schedule of concurrent cisplatin (cDDP) and 5-fluorouracil (5-FU) administered as protracted intravenous infusions (PVI) during hyperfractionated radiotherapy (HFRT) with organ-sparing intent in infiltrating transitional cell carcinoma of the bladder (TCCB). Seventy-seven patients with T2-T4a, NO, M0 TCCB were enrolled in this study. After a complete transurethral resection (TURB) and bladder mapping, 42/77 patients were submitted to two cycles of induction chemotherapy (CT). All 77 patients underwent HFRT and cDDP (4-6 mg/sqm/day) + 5-FU (180-220 mg/sqm/day) as concomitant PVI (RCT). Six to eight weeks after RCT, response was evaluated by computed tomography, urine cytology and TUR. In the case of complete response (CR) patients were followed up at regular intervals. In case of residual or recurrent invasive tumor salvage cystectomy was recommended. Seventy-two patients were evaluable for response: 65 had CR (90.3%) and 7 (9.7%) partial response (PR). No significant difference was observed according to different prognostic factors, except for stage (T2 95.7% vs T3-T4a 80.0%, p=0.04). The observed toxicity, mainly haematological, was higher in the group of patients treated by CT, even though the difference was not statistically significant. After a median follow-up of 82.2 months (range: 30-138 months), 44/65 (57.1%) CR patients are alive, of them 33 with their tumor-free bladder. Five-year overall, bladder intact, tumor-specific, disease-free and cystectomy-free survival were 58.5%, 46.6%, 75.0%, 53.5% and 76.1%, respectively, considering all 77 patients. The data suggest that this combined treatment provide high response rates and can be offered as an alternative option to radical cystectomy in selected patients who refuse or are unsuitable for surgery.

1097 poster

RT based bladder preservation treatment - in which patient?

B. Kra.qelf, C, Cufer 2, Bor~tnar 3, B. Sedmak 3

1Institute of Oncology, Radiotherapy, Ljubljana, Slovenia 2Institute of Oncology, Department of Medical Oncology, Ljubljana, Slovenia 3Cfinical Center Ljubljana, Department of Urology, Ljubljana, Slovenia

Introduction: Limited efficiency and considerable morbidity of transurethral resection (TUR) and radiotherapy (RT) that lessen the competitivity of bladder sparing treatment in invasive bladder cancer could be avoided by proper patient selection and lower RT dose.

Patients and methods: Evaluated were 31 pts with solitary, completely resected, T1-2 tumors, without uretheral obstruction and anemia - factors found to be predictive for local control and prognosis in pts treated with TUR, 2-4 cycles of MCV and RT. Median TD of evaluated pts was 50 Gy.