Endoscopic Gold Fiducial Marker Placement into the Bladder Wall to Optimize Radiotherapy Targeting for Bladder-Preserving Management of Muscle-Invasive Bladder Cancer: Feasibility and Initial Outcomes

About the Authors:

Maurice M. Garcia

* E-mail: [email protected]

Affiliations Department of Urology, University of California San Francisco, San Francisco, California, United States of America, University of California San Francisco – Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America

Alexander R. Gottschalk

Affiliations Department of Radiation Oncology, University of California San Francisco, San Francisco, California, United States of America, University of California San Francisco – Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America

Jonathan Brajtbord

Affiliation: Department of Urology, University of California San Francisco, San Francisco, California, United States of America

Badrinath R. Konety

Affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, United States of America

Maxwell V. Meng

Affiliations Department of Urology, University of California San Francisco, San Francisco, California, United States of America, University of California San Francisco – Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America

Mack Roach III

Affiliations Department of Urology, University of California San Francisco, San Francisco, California, United States of America, Department of Radiation Oncology, University of California San Francisco, San Francisco, California, United States of America, University of California San Francisco – Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America

Peter R. Carroll

Affiliations Department of Urology, University of California San Francisco, San Francisco, California, United States of America, University of California San Francisco – Helen Diller Family Comprehensive Cancer Center, San Francisco, California, United States of America

Introduction

Radical cystectomy with urinary diversion remains the gold-standard treatment for localized muscle-invasive bladder cancer. However, bladder preservation with tri-modality therapy (maximal transurethral resection, and combined chemo and radiotherapy) remains an alternative for patients who have been thoroughly counseled regarding the attendant risks and benefits of all management options, including radical cystectomy [1]. Ideal candidates for bladder sparing management should have low stage, focal disease that is amenable to complete transurethral tumor resection [2]. Despite the absence of direct randomized trials comparing bladder preserving treatment and radical cystectomy, tri-modality treatment with maximal transurethral bladder tumor resection followed by different regimens of combined radio and chemotherapy has, among patients with the aforementioned disease features, achieved results comparable to radical cystectomy in some trials [3].

Two key challenges to radiotherapy...