How do you determine your treatment volumes when treating with chemoradiation for bladder cancer?

Good question! The fields for bladder preservation with chemoradiation have not been standardized, and there are multiple reasonable options based on trials/experiences for certain fields. In general, it is important to try to minimize dose of RT to adjacent tissues that are more sensitive. Because ...

I have found that I can do a partial bladder boost most effectively by starting with the boost, when it is easiest for patients to maintain full bladder.

It is a great and difficult question, as evidenced by the SWOG trial @Dr. First Last referenced.

Perhaps the strongest evidence for concurrent chemotherapy comes from BC2001 (James et al. NEJM 2012), which showed a DFS benefit (and trend for OS). The protocol for that study describes 3D conformal te...

In my opinion, the most troubling organ in this situation is the small bowel. To my knowledge, there is no data on small bowel dose, nor have I ever seen it addressed in any bladder protocol. Yet, treating the bladder to full dose (either 55 Gy in 20 or conventional 64 Gy) would eclipse what we trad...

We believe that being able to reduce off some of the bladder reduces toxicity, although acknowledge that data are lacking. Knowing where to boost (identifying the reduction target) is often a challenge and we discuss each case and review films with our urologists. We have discussed placing markers o...