Page 87 - ARNM-3-2

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

A B

Figure 2. Schematic illustration of assessment of response post-radiotherapy and long-term outcomes. (A) Two patients showed disease progression
during RT. The initial response was assessed 3 months after RT in 12 patients. Seven (41%) patients had a complete response, and five (29%) patients
had stable disease post-RT; (B) Eight patients progressed post-RT, with six patients developing metastatic relapse and only two patients developing local
recurrence. Nine (53%) patients developed no progression.
Abbreviations: CRT: Chemoradiotherapy; CT: Computed tomography; OS: Overall survival; PFS: Progression-free survival; RT: Radiotherapy.

Figure 3. Kaplan–Meier survival analysis. After median follow-up of 15 months, ten patients had died: seven due to progressive disease, and three due
to unrelated causes. Seven (41%) patients were alive and well. The median progression-free survival was 15.8 months (95% CI: 12.4 – 64.6). The median
overall survival (OS) was 23.1 months (95% CI: 13.6 – 64.6) and the mean OS was 32.04 months (95% CI: 16.6 – 47.4).
Abbreviation: CI: Confidence interval.

4. Discussion Technological developments in RT delivery, from the
four-field box approach to three-dimensional conformal
This study provides a retrospective analysis of bladder
cancer patients who underwent RT (with or without RT (3D-CRT), IMRT, and VMAT, have made it possible to
concurrent chemotherapy) using a novel VMAT protocol. modulate the radiation dose, concentrating the high-dose
The protocol delivered 57.5 Gy in 23 fractions to the regions around the tumor while minimizing the dose to
bladder and primary tumor, as well as 46 Gy in 23 fractions adjacent OARs. When it comes to the definitive treatment
to the pelvic lymph nodes. Due to the comorbidities, low of bladder cancer, IMRT using the VMAT technique
fitness scores (ASA3 or ASA4, n = 7), adverse histology, may provide dosimetric and therapeutic advantages over
12
or personal choice, radical cystectomy was not considered 3D-CRT. A study by Sherry et al. reported the dosimetric
appropriate. Thus, these patients were treated with TMT, advantages of VMAT, observing over 50% reduction in
which involved TURBT followed by RT, and most patients the rectum and bowel (V40, V45, V50, V55, and V60)
also received concurrent chemotherapy. doses in the VMAT group compared to 3D-CRT. Daily

Volume 3 Issue 2 (2025) 79 doi: 10.36922/ARNM025090009