Australian & New Zealand Faculty of Radiation Oncology Genito‐Urinary Group: 2011 consensus guidelines for curative radiotherapy for urothelial carcinoma of the bladder

Abstract

Curative radiotherapy, with or without concurrent chemotherapy, is recognized as a standard treatment option for muscle-invasive bladder cancer. It is commonly used for two distinct groups of patients: either for those medically unfit for surgery, or as part of a 'bladder preserving' management plan incorporating the possibility of salvage cystectomy. However, in both situations, the approach to radiotherapy varies widely around the world. The Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recognised a need to develop consistent, evidence-based guidelines for patient selection and radiotherapy technique in the delivery of curative radiotherapy. Following a workshop convened in May 2009, a working party collated opinions and conducted a wide literature appraisal linking each recommendation with the best available evidence. This process was subject to ongoing re-presentation to the Faculty of Radiation Oncology Genito-Urinary Group members prior to final endorsement. These Guidelines include patient selection, radiation target delineation, dose and fractionation schedules, normal tissue constraints and investigational techniques. Particular emphasis is given to the rationale for the target volumes described. These Guidelines provide a consensus-based framework for the delivery of curative radiotherapy for muscle-invasive bladder cancer. Widespread input from radiation oncologists treating bladder cancer ensures that these techniques are feasible in practice. We recommend these Guidelines be adopted widely in order to encourage a uniformly high standard of radiotherapy in this setting, and to allow for better comparison of outcomes.

A dosimetric comparison of 3D conformal vs intensity modulated vs volumetric arc radiation therapy for muscle invasive bladder cancer

“…The CTV consisted of the gross tumour volume (GTV) and the whole bladder. As outlined in Australian and New Zealand consensus guidelines for bladder cancer radiotherapy [17], pelvic lymph nodes were not an elective part of the volume in any patient. The CTV to PTV margin was 1.5cm.…”

Prospective evaluation of definitive chemoradiotherapy with volumetric modulated arc therapy in patients with muscle invasive carcinoma of urinary bladder

“…In our study, contouring was done as per the consensus guideline given by Hindson et al . [ 14 ]. Gross tumour volume (GTV) was defined as macroscopic tumour visible on CT and/or on cystoscopy.…”

“…The primary clinical target volume (CTV-P) was contoured as GTV along with the whole bladder, identified by the outer bladder wall. CTV-P further included all anatomical variation such as cystocele and diverticulum [ 14 , 15 ]. In patient with tumours at the bladder base, the proximal urethra was also included in the CTV.…”

Outcome of patients with nonmetastatic muscle‐invasive bladder cancer not undergoing cystectomy after treatment with noncisplatin‐based chemotherapy and/or radiotherapy: a retrospective analysis

“…The median number of chemotherapy cycles administered to patients who received full chemotherapy was 7 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The median number of weekly gemcitabine doses administered as part of the radiochemotherapy regime was 6.…”