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How do you manage a bladder cancer patient who had a partial cystectomy with a positive margin?

What dose and fields of treatment would you recommend?
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What would be your recommendation for management of a bladder cancer patient who had a partial cystectomy with a positive margin, if repeat partial/radical cystectomy was not an option?

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3 Answers
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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on · Updated on

In fewer than 5% of bladder cancer patients, partial cystectomy along with neoadjuvant cisplatin-based chemotherapy can be considered for stage II (cT2, N0) disease with a single tumor in a suitable location and no presence of carcinoma in situ, where an adequate margin of soft tissue and an adequat...

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Radiation Oncology · Levine Cancer Institute
Answered on

Admittedly, I have not seen this precise situation. Presumably, that is because surgeons rarely perform partial cystectomy (radical is the standard of care). If they did and had a positive margin, presumably they would complete the radical and be done. Overall, my enthusiasm for "adjuvant" RT in thi...

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Radiation Oncology · UW Carbone Cancer Center
Answered on

As just one option for an otherwise poor-risk patient, which seems very plausible, given the similar toxicities in the accelerated doses of the RAIDER trial, one could consider dose escalation to 70 Gy (assuming optimal bladder location away from abutting bowel), with modified accelerated dose in fi...

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