Introduction & Objectives
To assess therapeutic approaches to muscle-invasive bladder cancer at Radiation Oncology Services in Spain.
Material & Methods
A specifically-designed questionnaire was submitted to Radiation Oncology Services in Spain via e-mail, to assess their therapeutic approach to bladder cancer over five years.
A total of 26 centers (30.5% of the total, of which 96% were public and 81% were university hospitals) answered the questionnaire. Of these, 92% reported to have a Urology Tumor Board that makes consensual decisions. 96% of these boards are composed of urologist, medical oncologist and radiation oncologist, and 62% have also pathologist and radiologist. Additionally, 77% of the respondent hospitals had designed a specific treatment protocol. Treatment approaches was reported to be systematically determined by the Board at 92% of hospitals. Treatments provided at hospitals for muscle invasive bladder cancer: A total of 100% of hospitals provide radical 3D conformal radiation therapy and three hospitals also performed IRMT and one Tomotherapy. The radiation therapy scheme designed for “bladder preservation” was reported to include both options: single-dose series (continuous irradiation without response evaluation after 40-45 Gy) or fractionated series (irradiation with response evaluation by cystoscopy and by radical transurethral resection after 40-45 Gy). A total of 64% of hospitals “always” perform single-dose series, of which 19% “sometimes” perform fractionated series. The average of patients on radical radiation therapy in 2010 was 51%, in 2013 was 47%, and in 2014 was 43%, with a statistically significant decreasing tendency (p=0.02).
At public hospitals in Spain, there are multidisciplinary urology tumor boards where urologists, radiation oncologists and medical oncologists collaborate to systematically make consensual decisions. In this period there is a significant downward trend in the use of radiotherapy for bladder sparing.