Would you consider definitive RT in a patient with oligometastatic bladder cancer who is not a surgical or chemotherapy candidate?

Would you consider 55 Gy in 20 fx to the primary followed by SBRT to oligo sites? Would you consider concurrent immunotherapy? Or would you just proceed on palliative route?

1 Answer

Mednet Member

Radiation Oncology · Michigan Healthcare Professionals, PC

Answered on

Oligometastatic bladder cancer has quite a poor prognosis and most local treatment in this setting is palliative in nature. Durable local control that provides hemostasis and prevents obstruction and other urinary issues is crucial. 30/10, 40/15, 55/20 are all potential options, but knowing that this is palliative, shorter courses may be a better option.

Out of the UK, a hypofractionated regimen of 36 Gy / 6 fx delivered weekly was shown to provide effective disease control with limited toxicity in patients that could not tolerate surgery or chemotherapy. They used conformal treatment planning and image guidance. Local control at 2 years exceeded 80% and 1-year survival was >60%. Grade 3 toxicity was seen in ~5% of patients.

I have used this regimen with success. Some patients will have hemostasis after 2-3 fractions and may decide that this is enough for them, and that is not an unreasonable approach - as many of these patients have limited life expectancy and this will do the job. This is also a reasonable approach for palliation of prostate cancer or definitive treatment in an M1 patient being treated for "cure".