Recommendations for planning and delivery of radical radiotherapy for localized urothelial carcinoma of the bladder.

Curative radio-chemotherapy is recognized as a standard treatment option for muscle-invasive bladder cancer (MIBC). Nevertheless, the technical aspects for MIBC radiotherapy are heterogeneous with a lack of practical recommendations.

In 2018, a workshop identified the need for two cooperative groups to develop consistent, evidence-based guidelines for irradiation technique in the delivery of curative radiotherapy. Two radiation oncologists performed a review of the literature addressing several topics relative to radical bladder radiotherapy: planning computed tomography acquisition, target volume delineation, radiation schedules (total dose and fractionation) and dose delivery (including radiotherapy techniques, image-guided radiotherapy (IGRT) and adaptive treatment modalities). Searches for original and review articles in the PubMed and Google Scholar databases were conducted from January 1990 until March 2020. During a meeting conducted in October 2020, results on 32 topics were presented and discussed with a working group involving 15 radiation oncologists, 3 urologists and one medical oncologist. We applied the American Urological Association guideline development's method to define a consensus strategy.

A consensus was obtained for all 34 except 4 items. The group did not obtain an agreement on CT enhancement added value for planning, PTV margins definition for empty bladder and full bladder protocols, and for pelvic lymph-nodes irradiation. High quality evidence was shown in 6 items; 8 items were considered as low quality of evidence.

The current recommendations propose a homogenized modality of treatment both for routine clinical practice and for future clinical trials, following the best evidence to date, analyzed with a robust methodology. The XXX group formulates practical guidelines for the implementation of innovative techniques such as adaptive radiotherapy.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2021 Jun 09 [Epub ahead of print]

Jonathan Khalifa, Stéphane Supiot, Géraldine Pignot, Christophe Hennequin, Pierre Blanchard, David Pasquier, Nicolas Magné, Renaud de Crevoisier, Pierre Graff-Cailleaud, Olivier Riou, Morgane Cabaillé, David Azria, Igor Latorzeff, Gilles Créhange, Olivier Chapet, Morgan Rouprêt, Sarah Belhomme, Arnaud Mejean, Stéphane Culine, Paul Sargos

Department of Radiotherapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France., Department of Radiotherapy, Institut de Cancérologie de l'Ouest, Nantes Saint-Herblain, France., Department of Urology, Institut Paoli Calmettes, Marseille, France., Department of Radiotherapy, Hôpital Saint Louis, Paris, France., Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France., Department of Radiotherapy, Centre Oscar Lambret, Lille, France., Department of Radiotherapy, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France., Department of Radiotherapy, Centre Eugène Marquis, Rennes, France., Department of Radiotherapy, Institut du Cancer de Montpellier, Montpellier, France., Department of Radiotherapy, Institut Bergonié, Bordeaux, France., Department of Radiotherapy, Clinique Pasteur, Toulouse, France., Department of Radiotherapy, Institut Curie, Paris, France., Department of Radiotherapy, Hospices Civils de Lyon, Lyon, France., Department of Urology, Hôpital Pitié-Salpétrière, APHP Sorbonne Université, Paris, France., Department of Medical Physics, Institut Bergonié, Bordeaux, France., Department of Urology, Hôpital Européen Georges-Pompidou, Paris, France., Department of Medical Oncology, Hôpital Saint-Louis, Paris, France., Department of Radiotherapy, Institut Bergonié, Bordeaux, France. Electronic address: .

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