What is your preferred dose and fractionation for muscle invasive bladder cancer and how do you decide between them?
What patient factors do you consider to decide between 55 Gy/20 fx and 64 Gy/32 fx with or without nodal irradiation? What if your patient is younger or older?
Answer from: Radiation Oncologist at Academic Institution
I'm using 5,500 cGy in 20 fractions since the Lancet Oncology meta-analysis. If I treat nodes, treat 4,400 cGy in the same 20 fractions. Seems like the mild-moderate toxicity might be higher than with 180-200 cGy/day regimen. The paper referenced above only assessed Grade 3 or higher toxicity. But t...
Comments
Radiation Oncologist at Radiant Oncology Do you deliver this whole bladder, treated with an...
Radiation Oncologist at Rutgers Cancer Institute of New Jersey Yes, whole bladder; empty; no cone down.
Radiation Oncologist at Jacob E Locke MD PA So meta-analysis is the new standard for picking r...
Radiation Oncologist at Rutgers Cancer Institute of New Jersey The paper I am referring to is better than some me...
Answer from: Radiation Oncologist at Community Practice
The question lacks specificity and forces a dogmatic answer. There are so many scenarios where I would treat the nodes, I may escalate the bladder, or even use a plan of the day. Performance status, use of chemo, presence of variant, histology, anatomy, etc., etc.
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Radiation Oncologist at University of Texas at Tyler Recall that the choice of radiation was not random...
Answer from: Radiation Oncologist at Academic Institution
If cN0, 55 Gy in 2 0Fx, entire bladder, simmed and treated empty, no cone down. No nodal RT.
If cN1, then I'd probably try to take nodes to higher than 55 Gy in 20 Fx as feasible and consider 44 in 20 ENI.
Do you deliver this whole bladder, treated with an...
Yes, whole bladder; empty; no cone down.
So meta-analysis is the new standard for picking r...
The paper I am referring to is better than some me...