Vienna, Austria

ESTRO 2023

Session Item

Poster (Digital)
Hypo-fractionated radiotherapy in elderly bladder cancer patients unfit for trimodal therapy.
Fatjona Kraja, Albania


Hypo-fractionated radiotherapy in elderly bladder cancer patients unfit for trimodal therapy.

Fatjona Kraja1, Aurel Janko2, Adrian Hoti3, Elona Tole4, Erald Karaulli1, Rezart Xhani2, Eugen Hoxha2, Bledi Kreka1

1University Hospital Center Mother Teresa, Oncology, Tirana, Albania; 2University Hospital Center Mother Teresa, Urology, Tirana, Albania; 3Catholic Hospital " Nostra Signora Del Buon Consiglio", Radiology, Tirana, Albania; 4Fier Regional Hospital, Oncology, Fier, Albania

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Purpose or Objective

Bladder cancer is common in patients over 65 years old. Patients with potentially curable muscle invasive bladder cancer (MIBC) who are unfit for surgery or trimodal treatment may be evaluated for hypo-fractionated radiation therapy (RT), as a potential curative treatment solution. The aim of our study was to evaluate the efficacy and toxicity of hypofractionated RT in MIBC, in elderly patients unfit for surgery or chemoradiation therapy.

Material and Methods

We retrospectively analyzed the data of 16 patients with confirmed nonmetastatic muscle-invasive carcinoma of the bladder, stage T2-T4aN0M0, who underwent transurethral resection of bladder cancer, and were treated with hypofractionated RT alone in our department from September 2018- October 2021. Patients’s Karnofsky Performance State was ≥ 60% and comorbidity was assessed by Charlson Comorbidity Index. Computed tomography imaging and cystoscopy and were used to evaluate treatment outcome.


Sixteen patients with mean age 78,7 years (range: 72-89 years) and Charlson Comorbidity Index ≥ 5 were analyzed. Male to female rate was 6:1. Pre-treatment staging was T3-T4N0 in 75% of patients and 41% had hydronephrosis. Nine patients (56%) had an uncomplete transurethral resection. 81% percent of the patients were treated with 3D Conformal Radiotherapy (3DCRT) and 19% with Intensity Modulated Radiation Therapy (IMRT). Patients were irradiated with 52.5-55 Gy in 20 fractions to the bladder only. All treatments were completed without interruption. The median follow-up time was 25 months (range:3-36 months). Acute gastrointestinal (GI) grade 2 and grade 3 toxicities occurred in 25% and 9%, respectively.The rate of acute genitourinary (GU) grade 2 and 3 toxicity were 35% and 25%. None of the patients developed GI and GU grade 4 acute toxicity. No statistically significant correlation was found between the radiotherapy technique and toxicity profile. Local control was achieved in 58% of the patients. Recurrent or progressive disease occurred in 24% of the patients. Overall survival at 1 year and 2 year was 83% and 58%, respectively. At the last follow up, 73% of the surviving patients had a functioning bladder.


Hypofractionation RT alone is a feasible, well tolerated and provides a good local control in elderly unfit patients for trimodal treatment achieving high biological effective dose with a minimal severe acute toxicity profile