Radiotherapy
Patterns of Failure
A study by Baumann et al evaluated the sites of local failure. For T3 tumours it is important to cover the presacral nodes as well as obturator and external iliac nodes.
Hypofractionation
Hypoxia and Hypoxic Cell Sensitisers
The use of hypoxic cell sensitisers has been explored in several studies. There are some improvements seen with use of these drugs
Guidelines
RANZCR FROGG guidelines published in the JMIRO provide good coverage of radiotherapy techniques for bladder cancer.
Patient factors:
- Reasonable life expectancy
- ECOG 0-2
- Good pretreatment bladder function
Tumour factors:
- Stage T2-T4a
- Multiple invasive tumours
- Hydronephrosis
- Carcinoma in situ outside invasive tumour region (poor response to RT)
Treatment factors:
- Maximal resection preserved
Planning points:
- CT guided simulation
- 3D CRT or IMRT
Volumes:
- GTV = residual tumour post TURBT
- CTVp = whole bladder. Expansion of 0.5 cm around tumour that extends outside bladder
- CTVn = not routine
- PTV =
Dose:
- 64 Gy in 32 fractions
- Avoid treatment delays
Dose constraints:
- Normal rectal constraints (V50 < 50, V60 < 35)
- Normal femoral head constraints (V50 < 30)
