FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC

Cardoso, Michael; Choudhury, Ananya; Christie, David; Eade, Thomas; Foroudi, Farshad; Hayden, Alix; Holt, Tanya; Kneebone, Andrew; Sasso, Giuseppe; Shakespeare, Thomas P.; Sidhom, Mark

doi:10.1111/1754-9485.13120

Cited by 4 publications

(10 citation statements)

References 63 publications

(122 reference statements)

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“…24 The use of hypoxia-modifying agents such as CON concurrently with RT in the management of MIBC is acceptable in the recently published FROGG clinical practice guidelines. 18 The standard RT dose recommended for BPTT was either 55 Gy in 20 fractions or 64 Gy in 32 fractions with concurrent chemotherapy. 18 Alternatively, hypofractionated RT alone using 55 Gy in 20 fractions with or without concurrent CON is offered.…”

Section: Discussionmentioning

confidence: 99%

“…18 The standard RT dose recommended for BPTT was either 55 Gy in 20 fractions or 64 Gy in 32 fractions with concurrent chemotherapy. 18 Alternatively, hypofractionated RT alone using 55 Gy in 20 fractions with or without concurrent CON is offered. 18 To reflect standard practice in Australia for the treatment of bladder cancer encompassing a traditional 2-Gy per day fractionation and a hypofractionated moderately accelerated schedule, our study considers both fractionation schedules, especially in a group of patients who are not suitable for chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…These radiation therapy doses are in accordance with recent FROGG consensus recommendation for MIBC. 18 Adaptive or non-adaptive treatment plans were created.…”

Section: Radiotherapy Techniquementioning

confidence: 99%

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Concurrent carbogen and nicotinamide with radiation therapy in muscle invasive bladder cancer: A report on feasibility in the Australian setting

et al. 2021

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Introduction: The incidence of bladder cancer increases with age, and elderly patients with muscle invasive bladder cancer (MIBC) are significantly undertreated. Bladder preservation trimodality therapy (BPTT) is an alternative to radical cystectomy in the curative setting. The use of concurrent carbogen and nicotinamide (CON) with radiation therapy (RT) as radiosensitisers have shown significant improvement in the overall survival and local relapse in the UK BCON Trial and is part of the standard of care for patients with MIBC in the UK. This is the first study in the Australian setting to demonstrate the feasibility in setting up a CON radiation oncology department. Methods: Based on the UK BCON trial, circuit systems for carbogen gas delivery were set up in consultation with the anaesthetics and respiratory teams. TGA exemption was obtained for 98% oxygen and 2% carbon dioxide carbogen gas mixture and delivery apparatus for each patient. Seven patients with histological locally advanced bladder cancer were recruited into this study. Results: The establishment of a CON department took approximately 24 months. Development of trial protocol was based on the equipment availability in Australia and proper transport, storage and handling of the equipment was guided by local occupational, health and safety (OHS) regulations. All patients received full of dose of CON. Increased urinary frequency, urgency and diarrhoea were the most commonly reported acute bladder and bowel toxicities. Conclusions: This is the first study in Australia to demonstrate the feasibility of concurrent CON with radiation therapy. It is a safe and cost-effective treatment that provides a new therapeutic option in the treatment of patients with MIBC, particularly those with limited treatment options.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Concurrent carbogen and nicotinamide with radiation therapy in muscle invasive bladder cancer: A report on feasibility in the Australian setting

et al. 2021

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“…Despite all UK radiotherapy centres being volumetric arc therapy (VMAT) or intensity-modulated radiotherapy (IMRT) enabled, and having conebeam computed tomography (CBCT) capabilities, the available state of the art radiotherapy techniques are not uniformly utilised, with only 45% of patients treated with a VMAT (30%) or IMRT (15%) technique [56] and 79% having CBCT for treatment verification. This is in contrast to practice in Australia and New Zealand, with 85% of radiation oncologists using VMAT or IMRT and 82% employing a daily soft-tissue match using CBCT [70]. Currently, national radiotherapy consensus statements for radiotherapy for MIBC do not exist in the UK, as they do in other countries [70] and have been shown to enhance treatment delivery and technique in other tumour sites [71].…”

Section: Evolution Of Radiotherapy Techniquementioning

confidence: 99%

“…This is in contrast to practice in Australia and New Zealand, with 85% of radiation oncologists using VMAT or IMRT and 82% employing a daily soft-tissue match using CBCT [70]. Currently, national radiotherapy consensus statements for radiotherapy for MIBC do not exist in the UK, as they do in other countries [70] and have been shown to enhance treatment delivery and technique in other tumour sites [71].…”

Section: Evolution Of Radiotherapy Techniquementioning

confidence: 99%

Overcoming the Chasm Between Evidence and Routine Practice for Bladder Cancer; Just a Quixotic Notion?

Varughese

2021

Clinical Oncology

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There has been a failure to improve outcomes in bladder cancer over the last 30 years. This is despite clinical trial evidence showing a benefit of interventions such as neoadjuvant chemotherapy or concurrent radiosensitisation for non-metastatic muscle-invasive bladder cancer. The bladder cancer population is characteristically elderly, who typically suffer from multiple comorbidities. Historically, radical cystectomy has been heralded as the treatment of choice, with radiotherapy being reserved for those with inoperable tumours or those unfit for major pelvic surgery, despite a lack of robust comparative or quality of life data to support one treatment recommendation over the other. Although patients with non-metastatic muscle-invasive bladder cancer have potentially curable disease, a growing body of population-based analyses persistently highlights that most patients do not undergo curative-intent treatments e a trend that remains static. The causes for the disparity between evidence and routine practice is not clearly understood. Here, the facets of patient-centred evidence-based care, with respect to bladder conservation therapy, are examined, with proposals to reverse this unacceptable status quo.

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Unwarranted variation in radiation therapy fractionation

Batumalai

James

2022

J Med Imag Rad Onc

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The adoption of hypofractionation across multiple tumour sites has been slow despite robust evidence. There is considerable unwarranted variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician preference, lack of technology and differing financial incentives. Unwarranted variation in the use of hypofractionation has a tremendous effect on cost to both patients and the healthcare system. This places an unnecessary burden on patients and poorly utilises scarce healthcare resources. A collaborative effort from clinicians, patients, healthcare providers and policymakers is needed to reduce unwarranted variation in practice. This will improve quality of care both for patients and at broader healthcare system level.

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FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC

Cited by 4 publications

References 63 publications

Concurrent carbogen and nicotinamide with radiation therapy in muscle invasive bladder cancer: A report on feasibility in the Australian setting

Concurrent carbogen and nicotinamide with radiation therapy in muscle invasive bladder cancer: A report on feasibility in the Australian setting

Overcoming the Chasm Between Evidence and Routine Practice for Bladder Cancer; Just a Quixotic Notion?

Unwarranted variation in radiation therapy fractionation

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