Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

Shahbaz, Muhammad; Ammar, Asif; Wang, Yuliang; Farhaj, Zeeshan; Qiao, Liang; Niu, Junchuan

doi:10.1590/s1677-5538.ibju.2019.0713

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…Radiotherapy may not be considered as monotherapy for treating MIBC. Instead, combined with chemotherapy and TURBT (Trimodal therapy) has essential effects in oncological outcomes of selected patients, even with fiducial markers as new tools for improving effectiveness (4,19).…”

Section: Radiotherapymentioning

confidence: 99%

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

et al. 2022

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Purpose: To describe the current scientifi c knowledge and clinical experience in low-grade-non-muscle-invasive bladder cancer (LG-NMIBC) patients in challenging scenarios. Materials and Methods: Medline, Embase, Google Scholar, and Cochrane Central were searched until March 2021. Results: A total of 841 studies were identifi ed, and abstracts were analyzed. Twentyone relevant studies were then identifi ed and reviewed. After all, information was gathered from 16 studies, the authors discussed the specifi c topics, and expert opinions were also included in the discussion. There have been some studies that can help us to have some insights on how to manage these patients. Very distinctive strategies have been reported in the literature, mainly anecdotally or in small randomized studies. Some of these treatments outlined in the present manuscript include repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, chemotherapy, and future perspectives. In the current manuscript, we have combined these strategies in a proposed algorithm. Conclusion: For those LG-NMIBC patients in challenging scenarios, we have found repeated TURBTs, chemoablation, BCG immunoablation, partial cystectomy, radical cystectomy, radiotherapy, and chemotherapy are attractive modalities to treat them effectively. Also, the current manuscript proposes an algorithm to overcome these challenges.

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Section: Radiotherapymentioning

confidence: 99%

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

et al. 2022

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“…Radical cystectomy (RC) is the mainstay of treatment of bladder cancer ( 1 , 2 ). Even if bladder sparing strategies are challenging the role of surgery ( 1 , 3 ), technical and technological advances are making the surgical procedure less invasive. RC is a complex procedure that may involve the combined surgery of the urinary and gastrointestinal tract ( 4 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration

et al. 2023

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Editorial Comment: Endoclips as novel fiducial markers in trimodality bladder preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

et al. 2021

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Titanium Endoclips (TE) are safe and not expensive. It has been applied in various tissues of the human body due to its high histocompatibility and no foreign body reaction. TE has also been used as a fiducial marker to assist radiotherapy in several tumors, helping the detection of the target area, reducing the damage to healthy tissues (1). When radiotherapy is planned, the inability to visualize the exact tumor location, due to the bladder wall movement, is by far the biggest challenge to be overcome. The search for the ideal fiducial marker is ongoing in bladder cancer, but today, despite the use of different agents and materials, (2-5) no ideal strategy was found. The concept to guide radiotherapy in partial bladder treatment opens perspectives for future studies to explore the benefits with its use. Among these benefits, it is noteworthy that partial bladder radiotherapy allows the increase of dose in a reduced volume of the organ based on the rationale of improving the local control, without a significant increase in toxicity (6). Currently, partial bladder radiotherapy is performed using findings from cystoscopy, and pre-surgical tomography (CT) or magnetic resonance (MRI) (7) but The clinical target volume (CTV) delimitation on the planning CT based on pre-surgical images brings uncertainty about the exact tumor boundaries (8). Consequently, to avoid tumor geographic missing, large margins on the CTV to generate the planning tumor volume (PTV) are required (9). The PTV with large volumes limits dose escalation due to the excessive risk of late complications. Thus, the endoscopic bladder fiducials to delimit the CTV give more precision to delineate the target allowing a reduced and more accurate CTV. Today, there are several forms of image-guided radiotherapy (IGRT) (10). The association between fiducial and IGRT would guarantee more precision to deliver the radiotherapy beam to the target. Among the IGRT system available, in special, IGRT with cone-beam CT combined with bladder fiducials would allow not only a reduction of margins with great precision, but it would also serve as an instrument to control the bladder volume during the radiotherapy fractions, translating in a more significant and realistic relationship between radiotherapy planning and treatment for the prediction of late complications (11). Adaptive radiotherapy combining the cone-beam CT images and treatment planning information still being developed, and in theory, has the potential of improving therapeutic ratio for bladder preservation. In this scenario, the bladder fiducial can have great value to adapt the treatment to the plans (10, 12, 13). On the other hand, even using simpler IGRT systems, such as planar images from kilovoltage or megavoltage sources, the bladder fiducial also brings precision in controlling the tumor bed's positioning EDITORIAL COMMENT

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Endoclips as novel fiducial markers in trimodality bladder-preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

Cited by 3 publications

References 15 publications

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

Challenging dilemmas of low grade, non-invasive bladder cancer: a narrative review

Reproducibility of a modified posterior reconstruction during robotic intracorporeal neobladder reconfiguration

Editorial Comment: Endoclips as novel fiducial markers in trimodality bladder preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient outcomes

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