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How do you approach elective nodal irradiation in muscle-invasive bladder cancer?
Surgical data suggests improved survival with pelvic lymphadenectomy and is recommended by NCCN guidelines, however the same is not seen with RT data. Why is there a discrepancy in nodal management? What factors influence your decision to treat nodes electively?
Answer from: Radiation Oncologist at Community Practice
The evidence regarding elective nodal irradiation (ENI) in patients undergoing organ preservation with chemotherapy and radiation is mixed, especially when considering data from surgical studies. A meta-analysis involving approximately 17,000 patients indicated that nodal dissection improved outcome...
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Answer from: Radiation Oncologist at Academic Institution
ENI unless there is a reason not to
Answer from: Radiation Oncologist at Academic Institution
Retrospective surgical studies suggest a survival benefit to a lymph node dissection versus cystectomy alone (e.g., Abdollah et al., PMID 21883849), although, to my knowledge, this has never been validated prospectively. Multiple retrospective surgical studies have also suggested that more extensive...
Answer from: Radiation Oncologist at Community Practice
Great comments! As pointed out, BC2001 without any nodal RT, only 10 pelvic nodal failures (out of 219 patients) were reported granted the vast majority of patients had T2N0 disease. An NCDB retrospective study looking at 2,000+ cN0 MIBC who completed CRT also did not appreciate any difference ...
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Radiation Oncologist at Varian Medical Systems/Allegheny health network
Favor nodal RT if otherwise suitable for surgery a...
Favor nodal RT if otherwise suitable for surgery a...