AccScience Publishing / ARNM / Online First / DOI: 10.36922/ARNM025090009
ORIGINAL RESEARCH ARTICLE

Radical radiotherapy using volumetric-modulated arc therapy for treating bladder and pelvic lymph nodes in locally advanced bladder cancer: A retrospective single-center study

Nilesh Tambe1 Stephen Kendall1 Vikram Bansal1 Faheem Bashir1 Theingi Aung1 Sanjay Dixit1 Pattu Pughazenthi1 Mohan Hingorani1*
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1 Department of Clinical Oncology, Queen’s Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, Yorkshire, United Kingdom
Received: 25 February 2025 | Revised: 17 March 2025 | Accepted: 7 April 2025 | Published online: 9 May 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The prognosis of patients with muscle-invasive bladder cancer (MIBC) and pelvic nodes remains poor. We developed a novel radiotherapy (RT) protocol using volumetric-modulated arc therapy (VMAT) to treat bladder and locoregional nodes in MIBC. This study explores the safety, efficacy, and development of the VMAT protocol. Between June 2020 and August 2024, a total of 17 patients were treated using the novel VMAT protocol. The treatment regimen consisted of 57.5 Gy in 23 fractions to the bladder and 46 Gy in 23 fractions to the pelvic nodes. The present study reports on various parameters, including patient-related, disease-related, and treatment-related characteristics, along with toxicity profiles and long-term outcomes (response rates, nature of progression, and survival). The RT protocol was well tolerated, with 15 patients (88%) completing treatment as planned. Most acute toxicities were grade 1 or 2. One patient (6%) experienced a grade 3 acute toxicity (pain and local discomfort), while two patients (12%) experienced grade 3 late toxicity (colovesical fistula and severe radiation-induced cystitis). Following treatment, 12 patients (71%) had a response or a stable disease. Two patients (12%) developed local recurrence, six (35%) developed metastatic relapse, and nine patients (53%) showed no progression. The median progression-free survival was 15.8 months (95% confidence interval [CI]: 12.4 – 64.6), while the median overall survival was 23.1 months (95% CI: 13.6 – 64.6). This study has several limitations, primarily due to its retrospective design and small patient cohort. Furthermore, there was considerable variability in histology, fitness scores, and concomitant chemotherapy treatment. Nonetheless, the findings demonstrate the safety and feasibility of the VMAT protocol for treating the bladder and pelvic nodes in locally advanced MIBC, and they provide a rationale for future prospective studies to further evaluate the role of pelvic RT in this population.

Keywords
Bladder cancer
Radiation therapy
Chemotherapy
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Print ISSN: 3060-8554, Published by AccScience Publishing