A comparison of morbidity following conformal versus intensity-modulated radiotherapy for urinary bladder cancer

Figures & data

Table I. Patient characteristics.

	All (n = 116)		CRT (n = 66)		IMRT (n = 50)
	n	%	n	%	n	%
Median age, range	75	46–85	75	46–85	76	46–83
Gender
Female	19	(16%)	13	(20%)	6	(12%)
Male	97	(84%)	53	(80%)	44	(88%)
Clinical T-stage
T1	4	(3%)	4	(6%)	0	–
T2	49	(42%)	26	(40%)	23	(46%)
T3	47	(41%)	27	(41%)	20	(40%)
T4	16	(14%)	9	(14%)	7	(14%)
N-stage
cN0/Nx	112	(97%)	63	(95%)	49	(98%)
cN+	4	(3%)	3	(5%)	1	(2%)
Multifocal
Present	29	(25%)	15	(23%)	14	(28%)
Absent	75	(65%)	44	(67%)	31	(62%)
Unknown	12	(10%)	7	(11%)	5	(10%)
Radical TURB
Yes	27	(23%)	12	(18%)	15	(30%)
No	89	(77%)	54	(82%)	35	(70%)
Carcinoma in situ
Present	29	(25%)	21	(32%)	8	(16%)
Absent	30	(26%)	11	(17%)	19	(38%)
Unknown	57	(50%)	34	(52%)	23	(46%)
Charlson index
None (0)	19	(16%)	13	(20%)	6	(12%)
Modest (1–2)	61	(53%)	29	(44%)	32	(64%)
Severe (3 +)	36	(31%)	24	(36%)	12	(24%)
WHO PS
0	79	(68%)	41	(62%)	38	(76%)
1	23	(20%)	16	(24%)	7	(14%)
2	4	(3%)	2	(3%)	2	(4%)
3	1	(1%)	0	–	1	(2%)
Unknown	9	(8%)	7	(11%)	2	(4%)
LN included
Yes	81	(70%)	39	(59%)	42	(84%)
No	35	(30%)	27	(41%)	8	(16%)

CRT, 3D conformal radiotherapy; IMRT, intensity-modulated radiotherapy; LN, lymph nodes included in the treated volume; PS, performance status; TURB, transurethral resection of the bladder.

Table II. Baseline and peak acute morbidity.

	Baseline morbidity						Peak acute morbidity
	Total		IMRT		CRT		Total		IMRT		CRT
	n	%	n	%	n	%	n	%	n	%	n	%
Grade 2 + Genitourinary
Frequency	44	(38)	24	(48)	20	(30)	77	(66)	33	(66)	44	(66)
Cystitis	0	(0)	0	(0)	0	(0)	14	(12)	6	(12)	8	(12)
Infection	3	(3)	3	(6)	0	(0)	18	(16)	8	(16)	10	(15)
Bladder pain	8	(7)	1	(2)	7	(11)	21	(18)	8	(16)	13	(20)
Grade 2 + Gastrointestinal
Diarrhoea	0	(0)	0	(0)	0	(0)	52	(45)	15	(30)	37	(56)
Bowel pain	2	(2)	2	(4)	0	(0)	9	(8)	5	(10)	4	(6)
Nausea	1	(1)	1	(2)	0	(0)	10	(9)	3	(6)	7	(10)
Proctitis	0	(0)	0	(0)	0	(0)	2	(2)	1	(2)	1	(2)

CRT, conformal radiotherapy; IMRT, intensity-modulated radiotherapy.

Figure 1. Median bowel cavity DVHs for patients with or without grade 2 + acute diarrhoea. Significant difference at 10 Gy, 20 Gy, 30 Gy, 40 Gy and 50 Gy (* p < 0.05).

Figure 2. Logistic regression curve for the risk of grade 2 + acute diarrhoea as a function of the bowel cavity receiving a dose of 45 Gy or higher (V_45Gy). The individual points represent the risk acute diarrhoea for six groups of 19–21 patients each arranged according increasing volume of bowel cavity receiving a dose of 45 Gy or higher.

Figure 3. Late gastrointestinal (GI) and genitourinary (GU) toxicity (CTCAE v.3) in the total patient cohort.