Adaptive Radiotherapy in Bladder Cancer: Phase II Results from the RAIDER II Trial
Adaptive radiotherapy is safe and feasible for muscle‑invasive bladder cancer, with a low rate of grade 3 toxicity and encouraging disease control.
The RAIDER II trial is a multicentre, randomised phase II study assessing adaptive radiotherapy (ART) techniques for muscle‑invasive bladder cancer. Three arms were compared: standard whole‑bladder radiotherapy, tumor‑focused boost with standard dose (SART arm) and the same boost with a 15 % dose escalation. Ninety‑seven % of patients received concomitant chemotherapy, most commonly 5‑FU/mitomycin. ART was delivered with daily cone‑beam CT and a three‑plan ‘plan‑of‑the‑day’ workflow. The primary endpoint was incidence of ≥grade 3 toxicity. ART achieved a 1.7 % grade‑3 toxicity rate, well below the pre‑specified 20 % threshold, and comparable to the standard arm. Disease‑control outcomes, including bladder‑intact event‑free survival, were numerically higher in the high‑dose arm (71.7 % vs. 66 %) but not statistically significant. Quality of life remained stable across groups. The study demonstrates ART is safe, tolerable, and feasible in a routine clinical setting, suggesting a potential shift toward bladder‑preserving radiotherapy strategies.
Improving precision in bladder radiotherapy may enhance organ preservation, reduce radiation‑related morbidity, and potentially improve oncologic outcomes in patients with muscle‑invasive bladder cancer.
Bizonyítékszint: Sejtvonalas. Laboratóriumi sejtekben vizsgálták.
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