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

rate. Moreover, the treatment was extremely effective from more aggressive (multimodality) therapies. The
in achieving good local control, with only two patients inclusion of biomarkers in future research is imperative to
developing local progression. Approximately 75% (n = 6) evaluate the treatment effects and outcomes. 26
of relapses were metastatic in nature. The above results
contradict those reported by Tan et al., in which 70% 5. Conclusion
9
of patients relapsed, and 52.6% developed locoregional The prognosis for patients with bladder cancer and pelvic
recurrence. In comparison, 52.9% of our patients remained nodes remains poor, and in the absence of surgery, most
disease-free, and most of the relapses (35%) were metastatic of these patients are treated with the best supportive care
in nature. The lower rates of overall relapse and local or palliative systemic therapy options. We successfully
recurrence observed in our study could be explained by implemented a novel pelvic RT protocol for MIBC
the shorter FU period or the potentially higher therapeutic treatment, which was well tolerated with low levels of
effectiveness of hypofractionated RT compared to clinically significant acute or late toxicities. The OAR
conventional RT. These results are encouraging, especially constraints were met using both TrueBeam and Halcyon
as they come from a subgroup of patients with a poor VMAT, with plans consisting of two arcs or three arcs. The
prognosis. present study demonstrates the safety and feasibility of
The current study has a number of limitations, most using this VMAT protocol in a fragile and prognostically
of which are associated with its retrospective design and unfavorable group of patients, with approximately 70%
small patient population. Furthermore, there was a notable response rate and more than 90% local control rate. Most
variation within the research cohort in terms of histology, relapses were metastatic in nature, with a median OS of
fitness ratings, and concomitant chemotherapy treatment. 23.1 months. The results from the study support the design
Moreover, in the absence of a direct comparison, the study of larger prospective studies to further evaluate the role of
cannot evaluate the dosimetric advantages of VMAT over RT in patients with MIBC and pelvic nodes.
standard conformal RT techniques. Thus, these results
should be interpreted with caution. However, the findings Acknowledgments
contribute significant information to the expanding body None.
of evidence, supporting the probable role of RT in treating
patients with MIBC and node-positive disease. The report Funding
emphasizes the need for further research and the planning None.
of larger prospective studies to explore the potential role of
RT in patients with MIBC and locoregional pelvic lymph Conflict of interest
nodes.
The authors declare that they have no competing interests.
Future research should explore the intriguing effects
of combining immunotherapy with RT. By targeting Author contributions
the programmed cell death 1 receptor, its ligand, or the
cytotoxic T lymphocyte antigen 4, immune checkpoint Conceptualization: Nilesh Tambe, Stephen Kendall, Mohan
inhibitors (ICIs) alter the immune response to cancer Hingorani
cells. Current phase 2 and phase 3 clinical trials are Formal analysis: Mohan Hingorani
22
investigating the addition of ICIs as the “fourth modality” Investigation: Nilesh Tambe, Stephen Kendall, Mohan
to trimodality treatment for localized MIBC. Preclinical Hingorani
23
data suggest that ICIs and RT may synergize, with radiation Methodology: Nilesh Tambe, Stephen Kendall, Mohan
stimulating an immune response by releasing antigens from Hingorani
the tumor, which has been hypothesized to account for the Writing – original draft: Nilesh Tambe, Stephen Kendall,
sporadic “abscopal” effects of radiation. The potential Mohan Hingorani
24
for dose-limiting GI toxicity (e.g., colitis) is one of the Writing – review & editing: All authors
primary concerns when combining immunotherapy and Ethics approval and consent to participate
RT, and this becomes particularly relevant once the pelvic
lymph nodes are included in the irradiated volumes. The study was reported to the Trust clinical governance
25
The presence of cancer cells induces a systemic response, team and the Audit Management and Tracking (AMaT)
leading to metabolic and immunological changes, which online portal. Due to the retrospective nature of the study,
can be assessed using biomarkers. These changes may help obtaining consent for participation from the study subjects
identify patients with high-risk diseases who could benefit was not feasible.

Volume 3 Issue 2 (2025) 83 doi: 10.36922/ARNM025090009