Bladder Cancer

RADIOTHERAPY PROCEDURES:

External Beam Radiotherapy - This treatment requires a planning session to be performed prior to beginning treatment. The planning session is performed in our treatment planning simulator room. A bladder catheter and rectal catheter are temporarily inserted and contrast material is instilled. X-rays are taken of the pelvic area. A CT scan is also performed. Once complete, the catheters are removed and the patient is sent home. The treatment planning technique used is called 3D conformal radiation. The CAT scan images are transferred to the treatment planning computer, and the tumor volume a well as normal tissue structures are drawn on each of the CAT scan images. The physician and Dosimetrist then work together to generate a treatment plan. Once this is complete, treatments can be initiated. On the first day of treatment, a block check is performed to make sure that what was planned on the computer matches what will be performed on the patient. Radiation treatments are given Monday through Friday, once a day, five days per week. Each treatment takes approximately 15 to 20 minutes to deliver. The treatment course for bladder cancer is approximately 7 weeks.

Interstitial Irradiation

This type of treatment for bladder cancer is used less frequently. It entails the placement of catheters directly into the wall of the bladder where the tumor is located. This is performed in the operating room with the aid of the urologist. The catheters are loaded with radiation sources at a later time. Once an adequate amount of radiation has been delivered, the sources of radiation and catheters are removed.

Intracavitary Irradiation

This form of treatment is rarely used. This treatment entails placement of radiation sources directly into the bladder itself. Again, the placement of the sources is for specified time.

RADIATION SIDE EFFECTS

Acute Side Effects

These side effects happen during radiation and go away once radiation has been completed. They include: urinary frequency, urgency, hesitancy, dysuria, decreased force of urinary stream, diarrhea, and fatigue. There are medications available for the majority of these side effects.

Late Side Effects

These side effects happen anywhere from 6 months to a few years following completion of radiation. They are rare, but can cause permanent problems. These include injury to the bladder itself, rectum, or small intestines.

FOLLOW-UP

Follow-up is performed with routine history and physical examination, cystoscopy and urine cytology every 3 months for 2 years, then every 6 months thereafter, and CT scans.

Larry N. Silverman, M.D.