The delivery of radical radiotherapy to the bladder and pelvis in node-positive (N1) bladder cancer: a five patient case series

In the UK over 10,000 new cases of bladder cancer were diagnosed in 2012, making it the seventh most common cancer in the UK. For those with advanced disease at presentation, prognosis is poor. Disease presenting with one pathological node (N1) is considered to be Stage 4 and is therefore considered the same as disease with widespread metastases. Pelvic lymph node dissection is considered standard when performing radical cystectomy; however, owing to potential toxicity, pelvic radiotherapy is not routine even when attempting radical treatment. We present five cases where radical treatment has been delivered to patients with node-positive bladder cancer. Treatment volumes included the whole bladder and bilateral pelvic nodes, and where it was felt appropriate, chemotherapy was delivered concurrently. Data has been collected by reviewing hospital notes including radiotherapy, volumes and dose distributions. Treatment was tolerated well with only minimal gastrointestinal and urinary symptoms reported. Three of the five patients had thrombocytopenia. This complication may be explained by the larger volume of radiation exposure. Local control appears to be good with all the patients having no pelvic relapse at the time of reporting. Two patients have relapsed with distant metastatic disease. No long-term side effects of therapy have been reported. Intensity-modulated radiotherapy techniques allow larger volumes to be treated owing to improved conformality and the resulting reduced toxicity. Treatment may be appropriate with both radical and adjuvant doses of radiation. More work is necessary to assess which patients would benefit and are most suitable for such treatment.