title: The outcome of a multi-centre feasibility study of online adaptive radiotherapy for muscle-invasive bladder cancer TROG 10.01 BOLART.
abstract: OBJECTIVE
  To assess whether online adaptive radiotherapy for bladder cancer is feasible across multiple Radiation Oncology departments using different imaging, delivery and recording technology.
  
  
  METHODS
  A multi-centre feasibility study of online adaptive radiotherapy, using a choice of three "plan of the day", was conducted at 12 departments. Patients with muscle-invasive bladder cancer were included. Departments were activated if part of the pilot study or after a site-credentialing visit. There was real time review of the first two cases from each department.
  
  
  RESULTS
  54 patients were recruited, with 50 proceeding to radiotherapy. There were 43 males and 7 females with a mean age of 78 years. The tumour stages treated included T1 (1 patient), T2 (35), T3 (10) and T4 (4). One patient died of an unrelated cause during radiotherapy. The three adaptive plans were created before the 10th fraction in all cases. In 8 (16%) of the patients, a conventional plan using a 'standard' CTV to PTV margin of 1.5cm was used for one or more fractions where the pre-treatment bladder CTV was larger than any of the three adaptive plans. The bladder CTV extended beyond the PTV on post treatment imaging in 9 (18%) of the 49 patients.
  
  
  CONCLUSIONS
  From a technical perspective an online adaptive radiotherapy technique can be instituted in a multi-centre setting. However, without further bladder filling control or imaging, a CTV to PTV margin of 7mm is insufficient.
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia. Electronic address: farshad.foroudi@petermac.org.
authors.forename: Farshad
authors.initials: F
authors.lastname: Foroudi
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pham
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Aldo
authors.initials: A
authors.lastname: Rolfo
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Calvary Mater Newcastle, Newcastle, Australia.
authors.forename: Colin I
authors.initials: CI
authors.lastname: Tang
authors.affiliation: Townsville Cancer Centre, Townsville, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Tan
authors.affiliation: Westmead Hospital, Sydney, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Turner
authors.affiliation: Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Hruby
authors.affiliation: Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Stephen
authors.initials: S
authors.lastname: Williams
authors.affiliation: Fremantle Hospital, Perth, Australia.
authors.forename: Dickon
authors.initials: D
authors.lastname: Hayne
authors.affiliation: Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Margot
authors.initials: M
authors.lastname: Lehman
authors.affiliation: Royal Hobart Hospital, Hobart, Australia.
authors.forename: Marketa
authors.initials: M
authors.lastname: Skala
authors.affiliation: Auckland Hospital, Auckland, New Zealand.
authors.forename: Chakiath C
authors.initials: CC
authors.lastname: Jose
authors.affiliation: Mater Centre, Brisbane, Australia.
authors.forename: Kumar
authors.initials: K
authors.lastname: Gogna
authors.affiliation: Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kron
mesh_terms: D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D059351:Organ Sparing Treatments / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*
keywords: Adaptive radiotherapy; Bladder cancer; Clinical trial; Image guided radiotherapy