What is the Optimal Dose, Fractionation and Volume for Bladder Radiotherapy?

Published on Apr 6, 2021in Clinical Oncology3.113
· DOI :10.1016/J.CLON.2021.03.013
Valérie Fonteyne27
Estimated H-index: 27
(Ghent University Hospital),
P. Sargos1
Estimated H-index: 1
External beam radiotherapy (EBRT), as part of a trimodality approach, is an attractive bladder-preserving alternative to radical cystectomy. Several EBRT regimens with different treatment volumes have been described with similar tumour control and, so far, clear recommendations on the optimal radiotherapy regimen and treatment volume are lacking. The current review summarises EBRT literature on dose prescription, fractionation as well as treatment volume in order to guide clinicians in their daily practice when treating patients with muscle-invasive bladder cancer. Taking into account literature on repopulation, continuous-course radiotherapy can be used safely in daily practice where a split-course should only be reserved for those patients who are fit enough to undergo a radical cystectomy in case of a poor early response. A recent meta-analysis has proven that hypofractionated radiotherapy is superior to conventional radiotherapy with regards to invasive locoregional control with similar toxicity profiles. In the absence of node-positive disease, the target volume can be restricted to the bladder. In order to compensate for organ motion, very large margins need to be applied in the absence of image-guided radiotherapy (IGRT). Therefore, the use of IGRT or an adaptive approach is recommended. Based on the available literature, one can conclude that moderate hypofractionated radiotherapy to a dose of 55 Gy in 20 fractions to the bladder only, delivered with IGRT, can be considered standard of care for patients with node-negative invasive bladder cancer.
#1Robert Huddart (ICR: Institute of Cancer Research)H-Index: 83
#2Shaista Hafeez (ICR: Institute of Cancer Research)
Last. Hybrid InvestigatorsH-Index: 1
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Purpose Hypofractionated radiation therapy can be used to treat patients with muscle-invasive bladder cancer unable to have radical therapy. Toxicity is a key concern, but adaptive plan-of the day (POD) image-guided radiation therapy delivery could improve outcomes by minimizing the volume of normal tissue irradiated. The HYBRID trial assessed the multicenter implementation, safety, and efficacy of this strategy. Methods HYBRID is a Phase II randomized trial that was conducted at 14 UK hospitals...
4 CitationsSource
#1Tru-Khang T. Dinh (UW: University of Washington)H-Index: 2
#1Tru Khang T. Dinh (UW: University of Washington)H-Index: 2
Last. Brian J. Davis (Mayo Clinic)H-Index: 37
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Purpose Definitive radiation therapy (RT), with or without concurrent chemotherapy, is an alternative to radical cystectomy for patients with localized, muscle-invasive bladder cancer (MIBC) who are either not surgical candidates or prefer organ preservation. We aim to synthesize an evidence-based guideline regarding the appropriate use of RT. Methods and Materials We performed a Preferred Reporting Items for Systematic Reviews and Meta-analyses literature review using the PubMed and Embase data...
2 CitationsSource
#1Ananya Choudhury (University of Manchester)H-Index: 28
Last. Bcon investigatorsH-Index: 1
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Summary Background Two radiotherapy fractionation schedules are used to treat locally advanced bladder cancer: 64 Gy in 32 fractions over 6·5 weeks and a hypofractionated schedule of 55 Gy in 20 fractions over 4 weeks. Long-term outcomes of these schedules in several cohort studies and case series suggest that response, survival, and toxicity are similar, but no direct comparison has been published. The present study aimed to assess the non-inferiority of 55 Gy in 20 fractions to 64 Gy in 32 fra...
5 CitationsSource
#1Shaista HafeezH-Index: 13
#2Amanda Webster (Mount Vernon Hospital)H-Index: 2
Last. Robert HuddartH-Index: 83
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Introduction Daily radiotherapy delivered with radiosensitisation offers patients with muscle invasive bladder cancer (MIBC) comparable outcomes to cystectomy with functional organ preservation. Most recurrences following radiotherapy occur within the bladder. Increasing the delivered radiotherapy dose to the tumour may further improve local control. Developments in image-guided radiotherapy have allowed bladder tumour-focused ‘plan of the day’ radiotherapy delivery. We aim to test within a rand...
3 CitationsSource
#1Shaista Hafeez (ICR: Institute of Cancer Research)H-Index: 13
#2Emma Patel (Mount Vernon Hospital)H-Index: 5
Last. Robert Huddart (ICR: Institute of Cancer Research)H-Index: 83
view all 10 authors...
Introduction Patients with muscle invasive bladder cancer (MIBC) who are unfit and unsuitable for standard radical treatment with cystectomy or daily radiotherapy present a large unmet clinical need. Untreated, they suffer high cancer specific mortality and risk significant disease-related local symptoms. Hypofractionated radiotherapy (delivering higher doses in fewer fractions/visits) is a potential treatment solution but could be compromised by the mobile nature of the bladder, resulting in ta...
10 CitationsSource
#1M.P. Tan (The Royal Marsden NHS Foundation Trust)H-Index: 1
#2V. Harris (Guy's and St Thomas' NHS Foundation Trust)H-Index: 1
Last. Robert Huddart (The Royal Marsden NHS Foundation Trust)H-Index: 83
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Abstract Aims Node-positive bladder cancer (NPBC) carries a poor prognosis and has traditionally been treated palliatively. However, surgical series suggest that a subset of NPBC patients can achieve long-term control after cystectomy and lymph node dissection. There is little published data regarding the use of radiotherapy to treat NPBC patients. This is in part due to concerns regarding the toxicity of whole-pelvis radiotherapy using conventional techniques. We hypothesised that, using intens...
2 CitationsSource
Abstract The most common treatment for non-metastatic muscle invasive bladder cancer (MIBC) is radical cystectomy with pelvic lymph node dissection. For selected patients, trimodal therapy (TMT) consisting in a maximal transurethral resection of the bladder, followed by a concurrent chemotherapy and radiotherapy, spread over 5 to 7 weeks, is considered as an acceptable option. We aimed to perform a systematic review to report the current results of curative hypo-fractionated radiotherapy in term...
4 CitationsSource
#1John J. CoenH-Index: 29
#2Peixin ZhangH-Index: 11
Last. William U. Shipley (Harvard University)H-Index: 100
view all 15 authors...
PurposeFluorouracil plus cisplatin and radiation twice a day (FCT) is an established chemoradiation (CRT) regimen for selective bladder-sparing treatment of muscle-invasive bladder cancer. Gemcitabine and once daily radiation (GD) is a well-supported alternative. The current trial evaluates these regimens.MethodsPatients with cT2-4a muscle-invasive bladder cancer were randomly assigned to FCT or GD. Patients underwent transurethral resection and induction CRT to 40 Gy. Patients who achieved a co...
28 CitationsSource
#1Shane D Collins (Trinity College, Dublin)H-Index: 1
#2Michelle Leech (Trinity College, Dublin)H-Index: 10
AbstractBackground: Large variations in the shape and size of the bladder volume are commonly observed in bladder cancer radiotherapy (RT). The clinical target volume (CTV) is therefore frequently inadequately treated and large isotropic margins are inappropriate in terms of dose to organs at risk (OAR); thereby making adaptive radiotherapy (ART) attractive for this tumour site. There are various methods of ART delivery, however, for bladder cancer, plan libraries are frequently used.Material an...
17 CitationsSource
Background and Purpose:Although there is a strong biological rationale to electively treat the pelvic nodes during bladder preservation, its clinical benefit is uncertain. This may be explained by the incidental dose received by the nodal regions when treating the bladder alone. This study was conducted to investigate the doses received by the different pelvic nodal regions when the bladder alone is treated by standard conformal radiotherapy.Methods and Materials:The computed tomography data set...
4 CitationsSource
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