Accelerated radiotherapy, carbogen, and nicotinamide (ARCON) in the treatment of advanced bladder cancer: mature results of a Phase II nonrandomized study

Int J Radiat Oncol Biol Phys. 2009 Apr 1;73(5):1425-31. doi: 10.1016/j.ijrobp.2008.06.1950. Epub 2008 Nov 25.


Purpose: We previously showed that accelerated radiotherapy combined with carbogen and nicotinamide (ARCON) was an effective approach to use in the radical treatment of patients with advanced bladder carcinoma. Interim analysis from this Phase II study showed that it achieved a high level of locoregional control and overall survival (OS) and an acceptable level of adverse events.

Methods and materials: From 1994 to 2000, a total of 105 consecutive patients with high-grade superficial or muscle-invasive bladder carcinoma were given accelerated radiotherapy (50-55 Gy in 4 weeks) with carbogen alone or ARCON. End points of the study were OS, disease-specific, and local regional relapse-free survival, and for late adverse events, urinary (altered urination frequency, incontinence, hematuria, and urgency) and bowel dysfunction (stool frequency and blood loss).

Results: At 5 and 10 years, local regional relapse-free survival rates were 44% after ARCON excluding the effect of salvage treatment and 62% after ARCON including the effect of salvage treatment (p = 0.04). Five- and 10-year rates were 35% and 27% for OS and 47% and 46% for disease-specific survival. The highest actuarial rate for Grade 3 or worse late urinary or bowel dysfunction was observed for altered urinary frequency (44% of patients had urinary events every 1 hour or less) and stool frequency of four or more events (26% at 5 years).

Conclusions: Historic comparisons with other studies indicate no evidence of an increase in severe or worse adverse events and good permanent control of bladder disease after ARCON radiotherapy.

Publication types

  • Clinical Trial, Phase II
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carbon Dioxide / administration & dosage*
  • Carcinoma in Situ / mortality
  • Carcinoma in Situ / pathology
  • Carcinoma in Situ / radiotherapy*
  • Cystectomy
  • Dose Fractionation, Radiation
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Niacinamide / administration & dosage*
  • Oxygen / administration & dosage*
  • Radiation-Sensitizing Agents / administration & dosage*
  • Remission Induction
  • Survival Rate
  • Urinary Bladder Neoplasms / mortality
  • Urinary Bladder Neoplasms / pathology
  • Urinary Bladder Neoplasms / radiotherapy*
  • Urinary Bladder Neoplasms / surgery


  • Radiation-Sensitizing Agents
  • Carbon Dioxide
  • Niacinamide
  • carbogen
  • Oxygen