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 control ...
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 to...
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...
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...
Systematic reviews show no consistent dose-response relationship (Tey et al., PMID 33591843). However, there may be a modest durability improvement with higher doses (Ogita et al., PMID 33953242). Furthermore, the evidence across all doses has similar high success rates, ~70-90%. Given that rapidity...