PURPOSE: The purpose of this study was to assess feasibility, clinical outcomes, and @entity137 in @entity1 with @entity150 treated with adaptive, image guided radiation therapy (IGRT) for bladder preservation as a part of trimodality treatment. The role of dose escalation was also studied. METHODS AND MATERIALS: Forty-four @entity1 with localized @entity150 were enrolled in a prospective study. They underwent maximal safe resection of @entity150 and concurrent @entity902 -based chemotherapy. @entity1 with large @entity5 were offered induction chemotherapy. Radiation therapy planning was done using either 3 (n=34) or 6 (n=10) concentrically grown planning target volumes ( @entity343 ). @entity1 received 64  Gy in 32 fractions to the whole bladder and 55  Gy to the pelvic nodes and, if appropriate, a simultaneous integrated boost to the @entity5 bed to 68  Gy (equivalent dose for 2-Gy fractions assuming a/b of 10 [EQD2]10  =  68.7  Gy). Daily megavoltage (MV) imaging helped to choose the most appropriate @entity343 encompassing bladder for the particular day (using plan-of-the-day approach). RESULTS: Most @entity1 (88%) had T2 disease. Sixteen @entity1 (36%) received neoadjuvant chemotherapy. A majority of the @entity1 (73%) received prophylactic nodal irradiation, whereas 55% of the @entity1 received escalated dose to the @entity5 bed. With a median follow-up of 30  months, the 3-year locoregional control (LRC), disease-free survival, and @entity1349 ( @entity1349 ) were 78%, 66%, and 67%, respectively. The bladder preservation rate was 83%. LRC (87% vs 68%, respectively, P=.748) and @entity1349 (74% vs 60%, respectively, P=.36) rates were better in @entity1 receiving dose escalation. Instances of acute and late Radiation Therapy Oncology Group (RTOG) grade 3 genitourinary @entity137 was seen in 5 (11%) and 2 (4%) @entity1 , respectively. There was no acute or late RTOG grade 3 or higher @entity344 . CONCLUSIONS: Adaptive IGRT using plan-of-the-day approach for bladder preservation is clinically feasible, with good oncological outcomes and low rates of acute and late @entity137 . Dose escalation is safe and possibly improves outcomes in bladder preservation.

Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for XXXX : A Prospective Study.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity', 'toxicities'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'tumors'] @entity343 :: ('187978', 'Species') :: ['PTV'] @entity344 :: ('MESH:D005767', 'Disease') :: ['gastrointestinal toxicity'] @entity150 :: ('MESH:D001749', 'Disease') :: ['bladder tumor', 'bladder cancer'] @entity902 :: ('MESH:D010984', 'Chemical') :: ['platinum'] @entity1349 :: ('MESH:D011475', 'Disease') :: ['OS', 'overall survival']
@entity150 :: (MESH:D001749,Disease) :: ['Urinary Bladder Cancer']
