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• W2895855311 abstract "This study was done to assess the clinical outcomes with dose escalated, image guided adaptive radiation therapy (ART) in patients of muscle invasive bladder cancer (MIBC), as a part of trimodality treatment approach for bladder preservation. Patients with non-metastatic MIBC treated with ART were analyzed. After maximal resection of bladder tumor, they were treated with radical chemoradiation. Neoadjuvant chemotherapy was offered to patients with large tumors. For ART, 3 anisotropic planning target volumes were concentrically grown (PTVs small, medium and large) around the bladder. A library of intensity modulated radiotherapy (IMRT) plans was created for each patient. A dose of 64 Gy in 32 fractions to the whole bladder and 55 Gy to the pelvic nodes was planned. In selected patients with solitary tumor or two tumors in close proximity, without any in situ carcinoma component, dose escalation to tumor bed to 68 Gy (equivalent dose for 2-Gy fractions assuming α/β of 10 [EQD2]10 = 68.7 Gy) was planned using a simultaneous integrated boost, and patients were treated with a comfortably full bladder. On-board daily megavoltage imaging was used every day to choose the most appropriate PTV encompassing the bladder (‘Plan-of-the-day’ approach) for each fraction. A total of 92 patients were analyzed. Most patients had T2 (71%) or T3 (18%) disease. Twenty patients (22%) received neoadjuvant chemotherapy and 76% received concurrent weekly chemotherapy (platinum-based in 53%, gemcitabine-based in 23%). Eighty-one patients (88%) completed the planned dose of 64 Gy to the whole bladder while 55 patients (60%) received 68 Gy to the tumor bed as boost. With a median follow-up of 24 months, 3-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) were 79%, 66%, and 73%, respectively. Eighty-four percent retained a disease-free bladder, while another 6% had non-muscle invasive recurrences managed conservatively. Patients receiving dose escalation to 68 Gy showed higher OS (78% vs 66%, p = 0.248) and DFS (71% vs 56%, p = 0.094). Acute and late Radiation Therapy Oncology Group (RTOG) grade 3 genitourinary (GU) toxicity was seen in 9% and 4% patients, respectively. Acute and late RTOG grade 3 gastrointestinal (GI) toxicity was seen in 0% and 3% patients, respectively. The incidence of grade 3 acute or late GU or GI toxicity was not found to be associated with dose escalation. Dose escalation with adaptive plan-of-the-day approach for bladder irradiation is clinically safe and effective. A high bladder preservation rate can be achieved without compromising on survival or toxicities using plan of the day ART." @default.
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• W2895855311 date "2018-11-01" @default.
• W2895855311 modified "2023-09-27" @default.
• W2895855311 title "Adaptive Radiation Therapy for Carcinoma of the Urinary Bladder: Plan of the Day Approach for Dose Escalation" @default.
• W2895855311 doi "https://doi.org/10.1016/j.ijrobp.2018.07.350" @default.
• W2895855311 hasPublicationYear "2018" @default.
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