Page 81 - ARNM-3-2

Advances in Radiotherapy &

Nuclear Medicine

ORIGINAL RESEARCH ARTICLE
Radical radiotherapy using volumetric-

modulated arc therapy for treating bladder and
pelvic lymph nodes in locally advanced bladder

cancer: A retrospective single-center study

Nilesh Tambe , Stephen Kendall , Vikram Bansal , Faheem Bashir ,
Theingi Aung , Sanjay Dixit, Pattu Pughazenthi , and Mohan Hingorani*

Department of Clinical Oncology, Queen’s Centre for Oncology and Haematology, Hull University
Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Yorkshire, United Kingdom

Abstract

The prognosis of patients with muscle-invasive bladder cancer (MIBC) and pelvic
nodes remains poor. We developed a novel radiotherapy (RT) protocol using
volumetric-modulated arc therapy (VMAT) to treat bladder and locoregional nodes in
MIBC. This study explores the safety, efficacy, and development of the VMAT protocol.
Between June 2020 and August 2024, a total of 17 patients were treated using the
novel VMAT protocol. The treatment regimen consisted of 57.5 Gy in 23 fractions to
*Corresponding author: the bladder and 46 Gy in 23 fractions to the pelvic nodes. The present study reports
Mohan Hingorani on various parameters, including patient-related, disease-related, and treatment-
(mohan.hingorani3@nhs.net)
related characteristics, along with toxicity profiles and long-term outcomes (response
Citation: Tambe N, Kendall S, rates, nature of progression, and survival). The RT protocol was well tolerated, with
Bansal V, et al. Radical
radiotherapy using volumetric- 15 patients (88%) completing treatment as planned. Most acute toxicities were
modulated arc therapy for treating grade 1 or 2. One patient (6%) experienced a grade 3 acute toxicity (pain and local
bladder and pelvic lymph nodes in discomfort), while two patients (12%) experienced grade 3 late toxicity (colovesical
locally advanced bladder cancer:
A retrospective single-center fistula and severe radiation-induced cystitis). Following treatment, 12 patients (71%)
study. Adv Radiother Nucl Med. had a response or a stable disease. Two patients (12%) developed local recurrence, six
2025;3(2):73-85. (35%) developed metastatic relapse, and nine patients (53%) showed no progression.
doi: 10.36922/ARNM025090009
The median progression-free survival was 15.8 months (95% confidence interval
Received: February 25, 2025 [CI]: 12.4 – 64.6), while the median overall survival was 23.1 months (95% CI: 13.6 –
Revised: March 17, 2025 64.6). This study has several limitations, primarily due to its retrospective design and
small patient cohort. Furthermore, there was considerable variability in histology,
Accepted: April 7, 2025
fitness scores, and concomitant chemotherapy treatment. Nonetheless, the findings
Published online: May 9, 2025 demonstrate the safety and feasibility of the VMAT protocol for treating the bladder
Copyright: © 2025 Author(s). and pelvic nodes in locally advanced MIBC, and they provide a rationale for future
This is an Open-Access article prospective studies to further evaluate the role of pelvic RT in this population.
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution, Keywords: Bladder cancer; Radiation therapy; Chemotherapy
and reproduction in any medium,
provided the original work is
properly cited.
Publisher’s Note: AccScience
Publishing remains neutral with 1. Introduction
regard to jurisdictional claims in
published maps and institutional Bladder cancer is the seventh most common cancer in the United Kingdom (UK),
1,2
affiliations. accounting for 3% of all cancers, with over 10,000 new cases diagnosed each year.

Volume 3 Issue 2 (2025) 73 doi: 10.36922/ARNM025090009