For gross hematuria from a primary bladder tumor, what palliative radiation regimen would you recommend?  

I found that 36 Gy/6 Fx delivered weekly is a great option for palliation.This has been used in curative system, as well, but I find it to be particularly helpful in elderly patients or those with travel issues. There is a phase 2 study in patients who are medically inoperable and the local con...

If metastatic, standard palliative doses are fine. I'm not sure of 21 Gy in 3 fx as a 'standard' palliative dose, however. If not metastatic and you think some, non-zero chance of getting to definitive treatment, QUAD-SHOT 14.8 Gy in 4 fx BID has been great at getting bleeding to cease. Most seem t...

Prospective evidence for 7 Gy x 3 (or 3.5 Gy x 10) comes from BA09: Duchesne et al., PMID 10802363.QuadShot originated with RTOG 8502, which treated advanced pelvic malignancies to 3 cycles. No difference was seen in outcomes or toxicity between q2 week vs q4 week interval between cycles. I am not a...

Ask yourself whether you are palliating just a symptom or the whole patient. For patients in this sort of situation (an acute presentation that worries everyone), I weigh each of these questions to establish the scope of what lies ahead, a map, the first question to ask is the performance status, th...

Systematic reviews show no consistent dose response relationship (Tey, J., Ho, F., Yao Koh, W., Chia, D., Huat Ooi, K., Tuan, J. K. L., … Yang Soon, Y. (2021). Palliative radiotherapy for bladder cancer: a systematic review and meta-analysis. Acta Oncologica, 60(5), 635–644. https://doi.org/10...

The original quad shot was 440 cGy for those keeping 'score' :)