Letter

145Urology Journal    Vol 6    No 2    Spring 2009

Re: Conservative Management of Early Bladder 
Rupture After Postoperative Radiotherapy for 
Prostate Cancer

Urol J. 2009;6:145. 
www.uj.unrc.ir

Sir, 
In Urology Journal 2008;5:269-71, Basiri 
and Radfar reported on the serious but rare 
complication of spontaneous intraperitoneal 
bladder rupture following salvage radiotherapy 
for biochemically recurrent prostate cancer.(1) 
This was successfully managed by conservative 
methods. Bladder rupture has been described 
as a complication of both pelvic external beam 
radiation therapy and brachytherapy in patients 
with cervical, prostate, and sarcomatous soft 
tissue malignances, but with a much longer 
latent period of 7 to 15 years. Unusually, this 
case occurred following salvage external beam 
radiation therapy for prostate cancer completed 
just 8 months previously and following an 
alternative hyperfractionated schedule of 72 Gy at 
1.2 Gy per day as stated. 

While there are hyperfractionated (< 2 Gy per 
day) regimens employed in the management of 
men undergoing definitive treatment of prostate 
cancer,(2) these have used as twice-daily treatment 
and have not been associated with increased acute 
or late toxicity. To my knowledge, there are no 
hyperfractionated salvage radiotherapy protocols 
for prostate carcinoma in current clinical use. 
While there are no details regarding bladder dose 
volume constraints, nor regarding on treatment 
urogenital toxicity, I am concerned that this 
unusual toxicity may have been related to the 

use of a nonstandard fractionation schedule in 
a patient who appeared to have an enhanced 
normal tissue reaction as evidenced by the soft 
tissue fibrosis they developed while on treatment. 
This case serves to reinforce the need for 
standardization of fractionation schedules in the 
multidisciplinary management of prostate cancer. 
This will be especially important as more patients 
with biochemical failure, margin positivity, or 
pT3 disease are referred for salvage or adjuvant 
radiation, based on recent demonstration of a 
survival advantage for these patients. 

Noel John Aherne
North Coast Cancer Institute, RCS Faculty 

of Medicine, University of New South Wales, 
Sydney, Australia

E-mail: noel.aherne@ncahs.health.nsw.gov.au

REFERENCES
1. Basiri A, Radfar MH. Conservative management of 

early bladder rupture after postoperative radiotherapy 
for prostate cancer. Urol J. 2008;5:269-71.

2. Forman JD, Duclos M, Shamsa F, Porter AT, Orton C. 
Hyperfractionated conformal radiotherapy in locally 
advanced prostate cancer: results of a dose escalation 
study. Int J Radiat Oncol Biol Phys. 1996;34:655-62.

3. Swanson, gP,  Thompson IM,  Tangen C, et al. 
Update of SwOg 8794: adjuvant radiotherapy for pT3 
prostate cancer improves metastasis free survival. Int 
J Radiat Oncol Biol Phys. 2008;72:s31.