Image-Guided Intensity Modulated Radiation Therapy (IMRT) for Bladder Cancer: Toxicity and Early Outcomes

and post-operative RT may be indicated in selected patients who are at high risk of local recurrence. The purpose of this study was to determine the frequency of preand post-operative radiation oncology (RO) consultation among patients who undergo cystectomy for bladder cancer in Ontario. Materials/Methods: Records of RT and surgery were linked to the Ontario Cancer Registry (OCR) to identify all patients who received treatment with curative intent for bladder cancer between 1994 and 2008. Billing records were linked to the OCR to determine whether those who underwent cystectomy had a RO consultation, either preor post-operatively. Factors associated with RO consultation were explored by logistic regression. Results: In total, 5259 patients with bladder cancer underwent treatment with curative intent in Ontario between 1994 and 2008. Of these, 3879 had primary cystectomy and 1380 had primary radiation therapy. Overall, only 370 (9.5%) of 3879 primary cystectomy patients had a pre-operative RO consultation, but rates varied widely from 3% to 33% among different regions of the province. These geographic variations were highly significant in a multivariate logistic regression (p<0.001), which also showed that older patients, residents of higher income neighborhoods, and those who had their surgery performed by “high volume” surgeons, were more likely to have a pre-operative RO consultation (all p<0.01). Overall, 386 (10%) of 3879 cystectomy patients had a post-operative RO consultation. Consultation rates varied from 6% to 44% across the province. These geographic variations were highly significant in the multivariate analysis (p<0.001), which also showed that younger patients, those with higher cancer stage (pT or pN), and those with positive margins, were more likely to have a post-operative RO consultation (all p<0.001). Nonetheless,, only 80 of 420 cases with positive margins (19%) had a post-operative RO consultation, of whom 35 received post-operative RT. Conclusions: Few patients who undergo cystectomy in Ontario have the benefit of either a pre-operative or post-operative opinion about the potential role of RT in their management. We recommend closer collaboration between radiation oncologists and urologists in the care of patients with bladder cancer. Author Disclosure: K. Zaza: None. C. Booth: None. R. Siemens: None. P. Peng: None. D. Berman: None. X. Wei: None. W. Kong: None. W.J. Mackillop: None.