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J Korean Soc Ther Radiol Oncol > Volume 20(2); 2002 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2002;20(2): 130-138.
The Prognostic Factors Affecting Survival in Muscle Invasive Bladder Cancer Treated with Radiotherapy
Woong Ki Chung, Bong Ryoul Oh, Sung Ja Ahn, Byung Sik Nah, Dong Deuk Kwon, Kwang Sung Park, Soo Bang Ryu, Yang IL Park
1Department of Therapeutic Radiology Chonnam National University Medical School, Chonnam National University Hospital, Kwangju, Korea. wkchung@chonnam.ac.kr
2Department of Urology, Chonnam National University Medical School, Chonnam National University Hospital, Kwangju, Korea.
This study analyzed the prognostic factors affecting the survival rate and evaluated the role of radiation therapy in muscle-invading bladder cancer.
Twenty eight patients with bladder cancer who completed planned definitive radiotherapy in the Departments of Therapeutic Radiology and Urology, Chonnam National University Hospital between Jan. 1986 to Dec. 1998 were retrospectively analyzed. The reviews were performed based on the patients' medical records. There were 21 males and 7 females in this study. The median of age was 72 years old ranging from 49 to 84 years. All patients were confirmed as having transitional cell carcinoma with histological grade 1 in one patient, grade 2 in 15, grade 3 in 9, and uninformed in 3. Radiation therapy was performed using a linear accelerator with 6 or 10 MV X-rays. Radiation was delivered daily with a 1.8 or 2.0 Gy fraction size by 4 ports (anterior-posterior, both lateral, alternatively) or 3 ports (Anterior and both lateral). The median radiation dose delivered to the isocenter of the target volume was 61.24 Gy ranging from 59 to 66.6 Gy. The survival rate was calculated by the Kaplan-Meier method. Multivariate analysis was performed on the prognostic factors affecting the survival rate.
The survival rate was 76%, 46%, 33%, 33% at 1, 2, 3, 5 years, respectively, with 19 months of median survival. The potential factors of age (less than 70 years vs above 70), sex, diabetes mellitus, hypertension, hydronephrosis, T-stage (T3a vs T3b), TUR, chemotherapy, total duration of radiotherapy, radiation dose (less than 60 Gy vs above 60 Gy), and the treatment response were investigated with uni- and multivariate analysis. In univariate analysis, the T-stage ( p=0.078) and radiation dose ( p=0.051) were marginally significant, and the treatment response ( p=0.011) was a statistically significant factor on the survival rate. Multivariate analysis showed there were no significant prognostic factors affecting the survival rate.
The treatment response and radiation dose are suggeted as the statistically significant factors affecting the survival rate of muscle invasive bladder cancer. A Further prospective randomized study is needed to confirm these prognostic factors.
Key Words: Bladder cancer, Radiotherapy, Survival rate, Prognostic factor
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