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Highlights from the American Society of Radiation Oncology (ASTRO) Annual Meeting |
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Managing Challenging Cases: Bladder Cancer
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| Node-Positive and Oligometastatic Disease
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| Leslie K. Ballas, MD
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| In the managing challenging bladder cancer cases session, Dr. Leslie Ballas presented on node-positive and oligometastatic disease in bladder cancer. To support her discussion, she highlights a clinical scenario of an 80 year old man with a 1-2 year history of gross hematuria who presented to the emergency department with clot retention.
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| Treatment Planning and Technique
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| Brian C. Baumann, MD
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| In the managing challenging bladder cancer cases session, Dr. Brian Baumann presented treatment planning and techniques. Dr. Baumann highlights several controversies in treatment planning including: Bladder only versus small pelvic fields versus extended nodal coverage, Whole bladder to full dose versus whole bladder to lower dose and partial bladder boost to full dose, Hypofractionation versus standard fractionation and Online adaptive versus non-adaptive.
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Bladder and Kidney Preservation
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| A Multi-Institutional Matched Comparison of Radical Cystectomy to Trimodality Therapy for Muscle Invasive Bladder Cancer
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| Jason A. Efstathiou, MD, DPhil
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| The 2022 ASTRO Annual Meeting featured a session on bladder and kidney preservation, including a presentation by Dr. Jason Efstathiou discussing a multi-institutional matched comparison of radical cystectomy to trimodality therapy for muscle invasive bladder cancer. Dr. Efstathiou and colleagues aimed to provide the best evidence possible on outcomes of matched cohorts comparing trimodality therapy (maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) to radical cystectomy in order to guide management.
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| Bladder Only vs. Bladder Plus Pelvic Lymph Node Chemoradiation for Muscle-Invasive Bladder Cancer
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| Sagar A. Patel, MD
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| In this presentation, Dr. Sagar Patel discussed bladder only versus bladder plus pelvic lymph node chemoradiation for muscle-invasive bladder cancer. The aims of this study were to (i) assess utilization trends of bladder only versus bladder + pelvic lymph node radiation for muscle-invasive bladder cancer in the United States, and (ii) evaluate whether survival outcomes are affected by bladder only versus bladder + pelvic lymph node treatment for muscle invasive bladder cancer treated with definitive chemoradiation.
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| Clinical Outcomes in cN+M0 Bladder Cancer Patients: Can the Bladder be Spared?
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| Martin Swinton, MD
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| In this presentation, Dr. Martin Swinton discussed clinical outcomes in cN+M0 bladder cancer patients. Optimal management of patients initially presenting with clinically node positive non-metastatic (cN+M0) bladder cancer is a topic of debate with significant variation in practice worldwide. Dr. Swinton and colleagues undertook a multi-center UK retrospective analysis to assess clinical outcomes for cN+M0 bladder cancer.
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| INTACT (S/N1806): Phase III Randomized Trial of Concurrent Chemoradiotherapy with or without Atezolizumab in Localized Muscle Invasive Bladder Cancer—Toxicity Update on First 213 Patients
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| Sameer Gokuldas Jhavar, MD, Ph.D.
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| Dr. Sameer Jhavar presented on toxicity updated results from the INTACT trial assessing concurrent chemoradiotherapy with or without atezolizumab in localized muscle invasive bladder cancer. The INTACT trial is evaluating the activity of atezolizumab in muscle invasive bladder cancer in combination with trimodality therapy. Moreover, it was designed with pre-specified safety analyses of the first 80 patients (40 in each arm).
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| Long-Term Outcomes of SABR to Primary Renal Cell Carcinoma: A Multicenter Analysis from IROCK (International Radiosurgery Oncology Consortium for Kidney)
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| Shankar Siva, Ph.D., MBBS, FRANZCR
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| During this presentation, Dr. Shankar Siva discussed the long-term outcomes of stereotactic ablative body radiotherapy to primary renal cell carcinoma from the International Radiosurgery Oncology Consortium for Kidney (IROCK). Patients with RCC not suitable for surgery have few curative treatment options, particularly as thermal ablation has diminishing efficacy in RCC masses > 3 cm or those that are adjacent to the collecting system. Dr. Siva and colleagues hypothesized that stereotactic ablative body radiotherapy represents an effective and safe, nephron-sparing alternative for RCC in the long-term.
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