title: Radical radiotherapy for invasive bladder cancer: What dose and fractionation schedule to choose?
abstract: OBJECTIVE
  To establish the alpha/beta ratio of bladder cancer from different radiotherapy schedules reported in the literature and provide guidelines for the design of new treatment schemes.
  
  
  METHODS
  Ten external beam radiotherapy (EBRT) and five brachytherapy schedules were selected. The biologically effective dose (BED) of each schedule was calculated. Logistic modeling was used to describe the relationship between 3-year local control (LC3y) and BED.
  
  
  RESULTS
  The estimated alpha/beta ratio was 13 Gy (95% confidence interval [CI], 2.5-69 Gy) for EBRT and 24 Gy (95% CI, 1.3-460 Gy) for EBRT and brachytherapy combined. There is evidence for an overall dose-response relationship. After an increase in total dose of 10 Gy, the odds of LC3y increase by a factor of 1.44 (95% CI, 1.23-1.70) for EBRT and 1.47 (95% CI, 1.25-1.72) for the data sets of EBRT and brachytherapy combined.
  
  
  CONCLUSIONS
  With the clinical data currently available, a reliable estimation of the alpha/beta ratio for bladder cancer is not feasible. It seems reasonable to use a conventional alpha/beta ratio of 10-15 Gy. Dose escalation could significantly increase local control. There is no evidence to support short overall treatment times or large fraction sizes in radiotherapy for bladder cancer.
authors.affiliation: Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. f.pos@nki.nl
authors.forename: Floris J
authors.initials: FJ
authors.lastname: Pos
authors.forename: Guus
authors.initials: G
authors.lastname: Hart
authors.forename: Christoph
authors.initials: C
authors.lastname: Schneider
authors.forename: Peter
authors.initials: P
authors.lastname: Sminia
mesh_terms: D001918:Brachytherapy / Q000592:standards*; D016001:Confidence Intervals; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D016015:Logistic Models; D011853:Radiobiology; D011879:Radiotherapy Dosage; D012062:Relative Biological Effectiveness; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy*