Given results of BCON trial, do you add carbogen and nicotinamide for patients receiving definitive radiotherapy for bladder cancer, particularly for non-cisplatin eligible candidates?  

BCON (Saunders et al., JCO 2010) showed an OS benefit (53yr OS 9% vs 46%) to adding the hypoxia modifying agents, carbogen gas and nicotinamide, to definitive RT for MIBC.  Given that most patients in USA who are referred for XRT are frail/elderly and not cisplatin candidates, has anyone administered these agents with XRT? Either with XRT alone, low-dose gemcitabine, or other chemotherapy? 

Other questions:

1) Does insurance cover these?

2) How challenging was it to incorporate into XRT workflow?