Bladder Cancer   

What dose and fields of treatment would you recommend? 

How do you decide between ureteral stent and percutaneous nephrostomy for decompression?

Surgical data suggests improved survival with pelvic lymphadenectomy and is recommended by NCCN guidelines, however the same is not seen with RT data....

The NCCN lists concurrent chemoradiotherapy as a primary treatment option in these patients. If so, what total dose do you deliver to involved ly...

Would treatment be palliative (i.e. for ureteral obstruction) or definitive? Is there a role for chemotherapy or hypofractionation/SBRT?

Has this recent retrospective analysis published in Lancet Oncology changed your practice?

Can chemoradiation be curative without maximal debulking TURBT?

If so, which checkpoint inhibitor would you use?

What patient factors do you consider to decide between 55 Gy/20 fx and 64 Gy/32 fx with or without nodal irradiation? What if your patient is younger ...

How do you decide between downstaging chemotherapy or upfront concurrent chemoradiotherapy? Both are listed as NCCN options. 

General recommendations on dose and management presuming unresectable. 

What is the potential risk of immunotherapy toxicity in combining palliative RT in a patient already on immunotherapy?

If you do recommend adjuvant therapy, what regimen would you use?

Weekly (20 mg/m2 D1, D2) and q 3 wks (70 mg/m2 x 3c or 100 mg/m2 x 3c) regimens have all been listed as acceptable.  For reference, RTOG 97&...

Specifically, for high grade T1 bladder cancer, is there evidence that definitive radiation yields similar control rates compared to cystectomy?

Would you do consolidation radiation or active surveillance? Would presence of variant histology change your recommendation?

The recommended concurrent chemotherapy regimens (cisplatin/paclitaxel and cisplatin/FU) in NCCN are based on BID fractionation of radiation as in RTO...

Any role for surgical extirpation vs systemic treatment?

Specifically, for cT2N0M0 small cell bladder cancer without response to neoadjuvant cisplatin and etoposide on imaging, would you proceed with cystect...

Current NCCN guidelines seem to support a variety of approaches.

Would you recommend radiation and/or systemic therapy? If you would irradiate, what would your fields/volumes look like? 

The current treatment for bladder adenoCA is surgery. However in non-surgical candidates, RT is an option. Would you consider adding chemo ? Also woul...

Would you offer it for positive margins? NCCN says to consider adjuvant radiation for pT3-T4 or pN0-2. Is there sufficient evidence for adjuvant radia...

If so, is there a role for IMRT?  I was taught to use the RTOG style ports with whole pelvis 4 field box and then boost field to entire bladder ...

For a patient with a history of non-muscle invasive disease in the bladder, presenting with a prostatic urethra only recurrence, do you approach this ...

I've heard justification for treating the whole bladder to 60-64 Gy based on the UK MRC study (James et al. NEJM 2012 and Huddart et al. IJROBP 2013) ...

In this case, the patient is currently on maintenance BCG.

Realistically, there will always be some (hopefully small) inconsistency with bladder filling, and thus some small bowel could easily receive &ge...

Assuming a patient who could tolerate either, which is preferred? Does this depend on the choice for concurrent chemotherapy (5FU+mitomycin vs ci...

Following a mini-pelvis field?

In the definitive setting, and would that change if cystecomy was planned if there was a complete response after CRT?  (similar to TCC paradigm).