بسم الله الرّحمن الرّحیم
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بسم الله الرّحمن الرّحیم. H. Emama M.D. Bladder Cancer. (Radiation Therapy) By: H. Emami Assistant professor of Radiation Oncology, Isfahan University of Medical Sciences, Isfahan, IRAN. Bladder Cancer. Superficial tumors TUR (standard).

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بسم الله الرّحمن الرّحیم

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4408974

بسم الله الرّحمن الرّحیم

H. Emama M.D.


4408974

Bladder Cancer

(Radiation Therapy)

By:

H. Emami

Assistant professor of Radiation Oncology,

Isfahan University of Medical Sciences,

Isfahan, IRAN.


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Bladder Cancer

Superficial tumors TUR (standard)

Low grade, Low stage Observation

High grade,

High stage,

Multifocal CIS

Multifocal Tumors

Tumor associated with CIS

If rapidly recur

Interavesical therapy

Or

Radical Cystectomy

Or

Bladder preserving


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Bladder Cancer

Radical Cystectomy (standard) + CT

CT + Radical Cystectomy if nodes are Negative

(NCCN) category 1

Muscle invasion

(T2)

Chemoradiation + CT

CT + Chemoradiation

Partial Cystectomy + CT

CT + Partial Cystectomy (NCCN)

Bladder Preservation


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Bladder Cancer

Muscle invasion (T2)

TURBT

Chemo-radiation

(40 - 45 Gy)

CR

In-CR

Consolidation

Chemo-radiation

(64 – 66 Gy)

Cystoscopic

Evaluation

Radical

Cystectomy

Recurrence


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Bladder Cancer

CT+Chemoradiation

CT + Radical Cystectomy (NCCN) category 1

Pre-op. Chemoradiation + Cystectomy

+ Post op. Chemotherapy

Perivesical fat

invasion (T3)


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Bladder Cancer

CT+Chemoradiation

CT + Radical Cystectomy in selected patient

Adjacent organ (s)

involvement(T4a)

Chemoradiation

Palliative therapy Radiation therapy

Chemotherapy

Involvement of pelvic or

Abdominal wall (T4b)


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Bladder Cancer

(Chemoradiation Therapy)

Pre-op. Chemoradiation or

Chemotherapy

(for down staging)

T2

T3

Selected T4a

Node negative

Residue

Positive LN(s)

No

New Bladder

Post op. Chemoradiation

(In high risk patients)


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Bladder Cancer

(Radiation Therapy)

1)-5000 cGy to the whole pelvis.

2)-Lateral boost to the bladder (1000 cGy).

3)-Cystectomy (4 to 6 week later).

Pre-op. Radiation therapy

Or Chemoradiation

(for down staging)

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

Chemoradiation therapy

(for bladder preservation)


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Bladder Cancer

(Palliative 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 times

600 cGy every week for 5 weeks


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Bladder Cancer

(Radiation Therapy Schedule)

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)


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Bladder Cancer

(Radiation Therapy Techniques)

Anterior-posterior portal Right lateral portal


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Bladder Cancer

(Radiation Therapy Techniques)

Box Tech. (whole pelvis) Box Tech. (Bladder)


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Bladder Cancer

(Radiation Therapy Techniques)

Two Lateral Arc Technique Three Field Arrangement


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Bladder Cancer

(Radiation Therapy)

-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.


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Isfahan

Isfahan

Khajo Bridge


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