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Mapping Local Failure Following Bladder Radiotherapy According to Dose.

H Abdel-Aty1, K Warren-Oseni2, S Bagherzadeh-Akbari2

  • 1Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.

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|June 12, 2022
PubMed
Summary
This summary is machine-generated.

Local relapse after muscle-invasive bladder cancer radiotherapy often occurs within the high-dose area. This suggests biological factors may drive failure, cautioning against margin reduction in future treatment protocols.

Keywords:
Bladder cancer radiotherapyIMRTdeformable registrationpatterns of local failure

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Muscle-invasive bladder cancer (MIBC) requires effective radiotherapy.
  • Understanding local relapse patterns is crucial for treatment optimization.

Purpose of the Study:

  • To investigate the relationship between radiation dose and local relapse in MIBC patients treated with intensity-modulated radiotherapy.
  • To analyze the spatial and dosimetric characteristics of local tumor relapse.

Main Methods:

  • Phase II study of intensity-modulated radiotherapy for MIBC.
  • Dose reconstruction of relapse gross tumor volume (GTV_relapse) using deformable image registration (DIR) and rigid image registration (RIR).
  • Classification of failure types based on spatial and dosimetric criteria.

Main Results:

  • 47% of patients experienced local relapse within the bladder.
  • Deformable image registration (DIR) indicated median GTV_relapse D98% and D95% at 97% and 98% of prescribed dose.
  • 65% of relapses were central high-dose failures (Type A), and 35% were peripheral high-dose failures (Type B).
  • No elective dose failures (Types C, D, E) were observed.

Conclusions:

  • Local relapse after MIBC radiotherapy occurs near the original tumor and within the high-dose region.
  • Findings suggest potential biological drivers for treatment failure.
  • Caution is advised regarding margin reduction in future radiotherapy protocols for MIBC.