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When treating bladder cancer with CRT in the bladder preservation paradigm, do you cone down to partial bladder or the whole bladder?
I've heard justification for treating the whole bladder to 60-64 Gy based on the UK MRC study (James et al. NEJM 2012 and Huddart et al. IJROBP 2013) and was wondering how often this is done? The UK MRC study used concurrent 5-FU/MMC rather than cisplatin - is there any reason to think that concurrent cis would lead to more toxicity than 5-FU/MMC?
Answer from: Radiation Oncologist at Academic Institution
I agree with @Anthony L. Zietman about whole vs. partial bladder "cone-down", although in my experience I'm much less like than @Anthony L. Zietman to treat partial bladder. In addition to the trials mentioned, the old SWOG experience (Combined 5-fluorouracil and irradiation for transition...
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Answer from: Radiation Oncologist at Academic Institution
I treat partial bladder when I can, maybe 2/3 of the time, and whole bladder when I can't, about 1/3 of the time. I have done this with platinum and 5-FU for many years and more recently with 5FU and MMC. Whole bladder seems equally tolerated for both chemo regimens but that is an unscientific compa...
Answer from: Radiation Oncologist at Community Practice
It is hard to say if cisplatinum would be more toxic than 5fu and mmc as there is no comparative study. Both have shown good tolerance independently with acceptable morbidities. One important caveat is dose of 5fu used in the study was half of what us used for anal cancer (500 vs 1000mg/m2) and coul...