Objectives: The objective was to calculate the toxicity of modified 
hypofractionated radiation combined with gemcitabine as well as local control, 
disease free survival (DFS), overall survival (OS), and bladder preservation rate 
in patient with muscle invasive bladder cancer (MIBC).
Methods: Weekly 100 mg/m2 doses of gemcitabine were utilized as a radio-
sensitizer. 30-minute intravenous infusion two to four hours before radiation 
treatment. Patients were treated with a hypo-fractionated radiation schedule 
utilizing a SIEMENS Linear accelerator over the course of four weeks and 
twenty-eight days, delivering 5250 cGy/20 fractions at 262.5 cGy per fraction.
Results: In the 82 cases of bladder cancer that were examined, we observed a 
significantly lower frequency of patients who suffered frequent urination 
(p=0.002), urgency (p=0.001), and proctitis (p=0.031) when comparing early 
and late toxicities. An overall bladder preservation rate of 87.8% is achieved in 
the majority of the analyzed cases (87.7%), with a regressive course in 59.8%, a 
stationary course in 28.0%, and a progressive course in ten cases (12.2%). 
Patients had a median follow-up time of 56 months after a 5-year observation 
period. (Range, 1 month to 8 years). At 94 months, the OS rate was 84.3% and 
at 93 months, the DFS rate was 82.8%.
Conclusion: Good efficacy and acceptable tolerability for a weekly, low-dose 
gemcitabine with hypofractionated radiation regimen in MIBC patients.