Page 84 - ARNM-3-2

Advances in Radiotherapy
& Nuclear Medicine Radiotherapy in node-positive bladder cancer

Figure 1. Dose distribution achieved with volumetric-modulated arc therapy (the dose color wash scale between 43.7 Gy [95% of the 46 Gy, node planning
target volume prescription] and the max dose). The images at the top show the primary and prophylactic node volumes, as well as organs-at-risk structures,
with dose distribution. The bottom images show the dose distribution for a node-positive patient, where the positive nodes received the same dose as the
primary (i.e., 57.5 Gy), and the elective nodes received 46 Gy in 23 fractions.

distribution of various patient-, tumor-, and treatment- (n = 1), cerebrovascular disease (n = 1), peripheral vascular
related variables. For the analysis of OS, disease-specific disease (n = 1), sleep apnea (n = 1), chromic paraplegia
death was considered the sole event, while patients who (n = 1), ischemic heart disease (n = 3), hypertension (n = 4),
were alive or had died from unrelated causes were censored and type II diabetes (n = 3). The majority of patients (n = 10)
at the time of their last visit. For PFS analysis, an event was had transitional cell carcinoma (TCC), followed by TCC
defined as disease progression or recurrence, as indicated with divergent squamous (n = 4), TCC with neuroendocrine
by radiological imaging and/or clinical deterioration. differentiation (n = 2), and pure poorly differentiated
The durations of PFS and OS were calculated from the neuroendocrine (small cell phenotype) carcinoma (n = 1).
date of diagnosis. Survival probabilities were estimated The distribution of T stages was T2 (n = 5), T3 (n = 10),
using the Kaplan–Meier method. All statistical analyses and T4 (n = 2). Two patients had N0 stage disease, and
were performed using the StatsDirect software system 15 patients had N1 stage disease, with positive pelvic nodes
(StatsDirect Ltd, Version 4, UK). on cross-sectional imaging (Table 1).

3. Results 3.2. Treatment characteristics and toxicity
(Tables 2 and 3)
3.1. Patient characteristics and disease features
3.2.1. Upfront (induction) chemotherapy
A total of 17 patients received RT to the bladder and pelvic
nodes using VMAT protocol, with a male predominance Ten patients (59%) received an upfront (induction)
(male, n = 12; female, n = 5). The median age was 66 years systemic anti-cancer therapy (SACT) before proceeding
(range: 30 – 83 years). The reasons for not proceeding to RT. The commonly employed regimens included
to surgery included locally advanced disease (n = 8), gemcitabine/cisplatin (n = 5), carboplatin/gemcitabine
concomitant comorbidities (n = 6), unfavorable histology (n = 1), atezolizumab (n = 1), cisplatin/etoposide
such as neuroendocrine transformation (n = 2), and (n = 1), carboplatin and etoposide (n = 1), and cisplatin/
patient choice (n = 1). The comorbidities, according to gemcitabine followed by pembrolizumab (n = 1). Seven
the American Society of Anesthesiologist status (ASA), patients (41%) proceeded to RT without any induction
were ASA1 (n = 6), ASA2 (n = 4), ASA3 (n = 5), and ASA4 chemotherapy.
(n = 2). The following comorbidities were frequently noted: The median number of cycles was three; however, at
pulmonary hypertension with Eisenmenger syndrome least two patients (12%) received a prolonged duration of

Volume 3 Issue 2 (2025) 76 doi: 10.36922/ARNM025090009