Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer
Purpose: Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging–guided...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109423000970 |
| _version_ | 1797805829680791552 |
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| author | Casey Liveringhouse, MD Alexander Netzley, BS John M. Bryant, MD Lauren C. Linkowski, MD Joseph Weygand, PhD Maria L. Sandoval, MD Ammoren Dohm, MD Marsha Dookhoo, RTT Stacey Kelley, CMD Stephen A. Rosenberg, MD, MS Kujtim Latifi, PhD Javier F. Torres-Roca, MD Peter A.S. Johnstone, MD Kosj Yamoah, MD, PhD G. Daniel Grass, MD, PhD |
| author_facet | Casey Liveringhouse, MD Alexander Netzley, BS John M. Bryant, MD Lauren C. Linkowski, MD Joseph Weygand, PhD Maria L. Sandoval, MD Ammoren Dohm, MD Marsha Dookhoo, RTT Stacey Kelley, CMD Stephen A. Rosenberg, MD, MS Kujtim Latifi, PhD Javier F. Torres-Roca, MD Peter A.S. Johnstone, MD Kosj Yamoah, MD, PhD G. Daniel Grass, MD, PhD |
| author_sort | Casey Liveringhouse, MD |
| collection | DOAJ |
| description | Purpose: Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging–guided radiation therapy (MRgRT) for partial bladder boost (PBB). Methods and Materials: A retrospective analysis was performed on consecutive patients with nonmetastatic muscle invasive bladder cancer who were treated with TMT using MRgRT between 2019 and 2022. Patients underwent intensity modulated RT-based nonadaptive MRgRT PBB contoured on True fast imaging with steady state precession (FISP) images (full bladder) followed sequentially by computed tomography–based RT to the whole empty bladder and pelvic lymph nodes with concurrent chemotherapy. MRgRT treatment time, table shifts, and dosimetric parameters of target coverage and normal tissue exposure were described. Prospectively assessed acute and late genitourinary and gastrointestinal (GI) toxicity were reported. Two-year local control was assessed with Kaplan-Meier methods. Results: Seventeen patients were identified for analysis. PBB planning target volume margins were ≤8 mm in 94% (n = 16) of cases. Dosimetric target coverage parameters were favorable and all normal tissue dose constraints were met. For MRgRT PBB fractions, median table shifts were 0.4 cm (range, 0-3.15), 0.45 cm (0-2.65), and 0.75 cm (0-4.8) in the X, Y, and Z planes, respectively. Median treatment time for MRgRT PBB fractions was 9 minutes (range, 6.9-17.4). We identified 32 out of 100 total MRgRT fractions that may have benefitted from online adaptation based on changes in organ position relative to planning target volume, predominantly because of small bowel (13/32, 41%) or rectum (8/32, 25%). Two patients discontinued RT prematurely. The incidence of highest-grade acute genitourinary toxicity was 1 to 2 (69%) and 3 (6%), whereas the incidence of acute GI toxicity was 1 to 2 (81%) and 3 (6%). There were no late grade 3 events; 17.6% had late grade 2 cystitis and none had late GI toxicity. With median follow-up of 18.2 months (95% CI, 12.4-22.5), the local control rate was 92%, and no patient has required salvage cystectomy. Conclusions: Nonadaptive MRgRT PBB is feasible with favorable dosimetry and low resource utilization. Larger studies are needed to evaluate for potential benefits in toxicity and local control associated with this approach in comparison to standard treatment techniques. |
| first_indexed | 2024-03-13T05:58:00Z |
| format | Article |
| id | doaj.art-739717f0514b4be0b78bbc799d30be49 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-03-13T05:58:00Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-739717f0514b4be0b78bbc799d30be492023-06-13T04:12:41ZengElsevierAdvances in Radiation Oncology2452-10942023-11-0186101268Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder CancerCasey Liveringhouse, MD0Alexander Netzley, BS1John M. Bryant, MD2Lauren C. Linkowski, MD3Joseph Weygand, PhD4Maria L. Sandoval, MD5Ammoren Dohm, MD6Marsha Dookhoo, RTT7Stacey Kelley, CMD8Stephen A. Rosenberg, MD, MS9Kujtim Latifi, PhD10Javier F. Torres-Roca, MD11Peter A.S. Johnstone, MD12Kosj Yamoah, MD, PhD13G. Daniel Grass, MD, PhD14Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaMorsani College of Medicine, University of South Florida, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaMorsani College of Medicine, University of South Florida, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FloridaDepartment of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida; Corresponding author: G. Daniel Grass, MD, PhD.Purpose: Bladder preservation with trimodal therapy (TMT; maximal tumor resection followed by chemoradiation) is an effective paradigm for select patients with muscle invasive bladder cancer. We report our institutional experience of a TMT protocol using nonadaptive magnetic resonance imaging–guided radiation therapy (MRgRT) for partial bladder boost (PBB). Methods and Materials: A retrospective analysis was performed on consecutive patients with nonmetastatic muscle invasive bladder cancer who were treated with TMT using MRgRT between 2019 and 2022. Patients underwent intensity modulated RT-based nonadaptive MRgRT PBB contoured on True fast imaging with steady state precession (FISP) images (full bladder) followed sequentially by computed tomography–based RT to the whole empty bladder and pelvic lymph nodes with concurrent chemotherapy. MRgRT treatment time, table shifts, and dosimetric parameters of target coverage and normal tissue exposure were described. Prospectively assessed acute and late genitourinary and gastrointestinal (GI) toxicity were reported. Two-year local control was assessed with Kaplan-Meier methods. Results: Seventeen patients were identified for analysis. PBB planning target volume margins were ≤8 mm in 94% (n = 16) of cases. Dosimetric target coverage parameters were favorable and all normal tissue dose constraints were met. For MRgRT PBB fractions, median table shifts were 0.4 cm (range, 0-3.15), 0.45 cm (0-2.65), and 0.75 cm (0-4.8) in the X, Y, and Z planes, respectively. Median treatment time for MRgRT PBB fractions was 9 minutes (range, 6.9-17.4). We identified 32 out of 100 total MRgRT fractions that may have benefitted from online adaptation based on changes in organ position relative to planning target volume, predominantly because of small bowel (13/32, 41%) or rectum (8/32, 25%). Two patients discontinued RT prematurely. The incidence of highest-grade acute genitourinary toxicity was 1 to 2 (69%) and 3 (6%), whereas the incidence of acute GI toxicity was 1 to 2 (81%) and 3 (6%). There were no late grade 3 events; 17.6% had late grade 2 cystitis and none had late GI toxicity. With median follow-up of 18.2 months (95% CI, 12.4-22.5), the local control rate was 92%, and no patient has required salvage cystectomy. Conclusions: Nonadaptive MRgRT PBB is feasible with favorable dosimetry and low resource utilization. Larger studies are needed to evaluate for potential benefits in toxicity and local control associated with this approach in comparison to standard treatment techniques.http://www.sciencedirect.com/science/article/pii/S2452109423000970 |
| spellingShingle | Casey Liveringhouse, MD Alexander Netzley, BS John M. Bryant, MD Lauren C. Linkowski, MD Joseph Weygand, PhD Maria L. Sandoval, MD Ammoren Dohm, MD Marsha Dookhoo, RTT Stacey Kelley, CMD Stephen A. Rosenberg, MD, MS Kujtim Latifi, PhD Javier F. Torres-Roca, MD Peter A.S. Johnstone, MD Kosj Yamoah, MD, PhD G. Daniel Grass, MD, PhD Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer Advances in Radiation Oncology |
| title | Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer |
| title_full | Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer |
| title_fullStr | Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer |
| title_full_unstemmed | Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer |
| title_short | Trimodal Therapy Using an MR–guided Radiation Therapy Partial Bladder Tumor Boost in Muscle Invasive Bladder Cancer |
| title_sort | trimodal therapy using an mr guided radiation therapy partial bladder tumor boost in muscle invasive bladder cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2452109423000970 |
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