“I think this is a multidisciplinary approach,” says Monika Joshi, MD, MRCP.
In this video, Monika Joshi, MD, MRCP, discusses patient factors and contraindications for radiotherapy for bladder cancer. Joshi is an associate professor of medicine, Endowed Associate Professor in Cancer Clinical Investigation, Endowed Professor in Cancer Clinical Investigation, and an assistant professor in the department of medicine at Penn State Cancer Institute in Hershey, Pennsylvania.
What makes a patient ideal for radiotherapy for bladder cancer? What are contraindications?
I think this is a multidisciplinary approach. So we really have to select these patients carefully. And we have to bear in mind that there are 2 important baskets of factors. One is the tumor and the other is the patient factors that could determine suitability of radiation therapy for organ preservation purposes. So if you look at the tumor, one has to make sure that patients can get maximum debulking TURBT; that's important. Patients have better outcomes with complete TURBT. We're also looking to make sure that they don't have moderate or severe hydronephrosis because studies in the past have shown that those patients may not benefit from the chemo RT approach. In addition, we look for at least minimal or absence of multifocal carcinoma in situ, so less is better, and solitary tumor or tumors less than 6 cm. And like I was saying before, node-negative patients have had better responses. That may change with more research coming as we had discussed before, but I think that's important. From the patient aspect, you have to make sure patients want this. Also, the comorbidities are important. Having good renal function and bladder function are also important. Some of the contraindications that we have come across is if patients have previous history of pelvic radiation then they don't qualify, or if they have any inflammatory disease then they are not good candidates. And of course, we talked about how important it is to have good urinary function. So if patients have multiple incontinence issues, then you worry about more toxicity.
This transcript was edited for clarity.