Management of Muscle-Invasive Bladder Urothelial Carcinoma in a South Asian Adult Man: Utility of Adaptive Radiotherapy in a Resource-Limited Country.

Urinary bladder cancer contributes significantly to the global cancer burden and is more prevalent in the developed world. We present the case of a 54-year-old male smoker who underwent transurethral resection of bladder tumor and consequent trimodality therapy (induction chemotherapy followed by concomitant chemo-radiotherapy). His disease was staged at cT3N0M0. Cone beam computed tomography (CBCT) and plan-of-the-day adaptive radiotherapy (ART) were utilized to treat muscle-invasive bladder urothelial carcinoma (MIBC). Instead of the usual planning treatment volume (PTV) of 2 cm, the disease-free state was achieved with a small PTV of 5 mm in 18 fractions and a large PTV of 1.5 cm in two fractions only. The volume of bowel saved with this strategy was 180 cc. The patient tolerated the treatment well with no side effects and is living a healthy life till date. CBCT-guided ART with plan-of-the-day approach is a precise and effective approach for the management of MIBC within limited resources.