16
H. Emama M.D .
H. Emama M.D.
(Radiation Therapy)
By:H. Emami
Assistant professor of Radiation Oncology,Isfahan University of Medical Sciences,
Isfahan, IRAN.
Superficial tumors TUR (standard)
Interavesical therapyOr
Radical CystectomyOr
Bladder preserving
Low grade, Low stage Observation
High grade,High stage,Multifocal CISMultifocal Tumors Tumor associated with CISIf rapidly recur
Muscle invasion(T2)
Radical Cystectomy (standard) + CTCT + Radical Cystectomy if nodes are Negative (NCCN) category 1
Chemoradiation + CT
CT + Chemoradiation
Partial Cystectomy + CT
CT + Partial Cystectomy (NCCN)
Bladder Preservation
Muscle invasion (T2)TURBT
Chemo-radiation(40 - 45 Gy)
CystoscopicEvaluation
Consolidation Chemo-radiation
(64 – 66 Gy)
RadicalCystectomy
CR In-CR
Recurrence
Perivesical fatinvasion (T3)
CT + Chemoradiation
CT + Radical Cystectomy (NCCN) category 1
Pre-op. Chemoradiation + Cystectomy + Post op. Chemotherapy
Adjacent organ (s)involvement(T4a)
CT + Chemoradiation
CT + Radical Cystectomy in selected patient
Involvement of pelvic or Abdominal wall (T4b)
ChemoradiationPalliative therapy Radiation therapy Chemotherapy
T2T3Selected T4a
Pre-op. Chemoradiation or Chemotherapy
(for down staging)
Post op. Chemoradiation(In high risk patients)
Residue
Positive LN(s)
(Chemoradiation Therapy)
Node negative
NoNew Bladder
1)-5000 cGy to the whole pelvis.2)-Lateral boost to the bladder (1000 cGy). 3)-Cystectomy (4 to 6 week later).
1)-4500-5000 cGy to the whole pelvis + bladder boost Total dose 6400-6600 cGy +Cisplatin, Carboplatin, Paclitaxel, 5FU, Gemcitabine (low dose )(33mg/m2 twice weekly)Mytomycin-C + 5FU (NCCN) 2)- Two course MCV , then Chemoradiation
Pre-op. Radiation therapyOr Chemoradiation(for down staging)
Chemoradiation therapy(for bladder preservation)
(Radiation Therapy)
Bone metastasis
Hematuria
Lung and Liver Met. Chemotherapy
3000 CGY in 10 fractions.4000 CGY in 20 fractions.
1000 cGy in one fraction.1000 cGy every 3-4 week for 3 times600 cGy every week for 5 weeks
(Palliative Therapy)
1)-Convential (180-200 cGy/day) (Total 6400 cGy)
2)-Hyper fractionation (100 cGy X 3 times/day) (total 8400 cGy)
1000 cGy in one fraction 2100 cGy in 3 fractions 3)-Hypo fractionation 3500 cGy in 10 fractions 600 cGy weekly (total 3000 cGy 600 cGy weekly (total 3600 cGy)
(Radiation Therapy Schedule)
(Radiation Therapy Techniques)
Anterior-posterior portal Right lateral portal
Box Tech. (whole pelvis) Box Tech. (Bladder)
(Radiation Therapy Techniques)
Two Lateral Arc Technique Three Field Arrangement
(Radiation Therapy Techniques)
-External beam radiation is rarely appropriate for patients with recurrent Ta and T1 tumor or diffuse Tis.
-simulate and treat patients with bladder empty.
-use multiple fields from high-energy linear accelerator beams.
-Treat the whole bladder with or without pelvic lymph nodes with 45-50 Gy and then boost the bladder tumor to total dose
of 64-66 Gy.
-Consider low-dose pre-operative radiation prior to segmental resection for invasive tumors .
(Radiation Therapy)
