S3011
Invited Speaker
ESTRO 2026
difference in outcome was seen between those and patients having lesser resections. Both BC2001 and BCON reflect treatment which was current over 20 years and the fact that they remain the mainstay of current treatment schedules is a reflection of the limited progress which until recently has been made in the area. In the current setting can we still propose radiotherapy with 5FU and mitomycin C, gemcitabine or cisplatin as standard of care? Is hypoxia modification still relevant? It is notable that neoadjuvant chemotherapy, whilst a standard for cystectomy is not consistently used with TMT. However radiotherapy patients were included in the seminal EORTC/MRC 30894 with a similar survival advantage to that seen in the cystectomy patients. With the current emerging evidence of efficacy from both durvalumab and EVP is it still appropriate to deny radiotherapy patients modern neoadjuvant schedules? Radiotherapy itself has undergone considerable technical advances in the past 20 years. Hypofractionation has become established as a safe and effective approach and in MIBC has been demonstrated if anything to be superior to conventional fractionation. Complex planning techniques using IMRT and VMAT are now routine minimising normal tissue inclusion in treatment volumes. Adaptive approaches recognising that the bladder is one of the most variable organs day to day in terms of size and shape have evolved. In many sites stereotactic radiotherapy techniques have become established and this is now being explored for bladder cancer enabling even more extreme hypofractionation. Does modern state of the art hypofractionated radiotherapy with a sensitiser still have a role in the era of IO and antibody drug conjugates which can achieve complete remissions? Considering parallels with other disease settings where high remission rates with systemic therapy are seen, radiotherapy will still have an important role in maintaining long term local control. Optimal outcomes will be achieved with combined modality schedules integrating the best systemic options with effective local control using radiotherapy. 5343 Ablation for HCC according to the interventional radiologist Laura Crocetti Interventional Radiology, University of Pisa, Pisa, Italy Hepatocellular carcinoma (HCC) remains a major global cause of cancer-related mortality, but the increasing diagnosis of very early and early-stage disease has strengthened the role of curative-intent locoregional therapies. In this setting, the concept of
biomarkers that move beyond prognostic classification and support biologically informed treatment selection. Although the most mature clinical evidence currently comes from post-cystectomy studies, these data provide an important framework for translating molecular residual disease concepts into bladder preservation. This talk will review tumour-based and liquid biopsy biomarkers in MIBC, including molecular subtypes, immune-related features and DNA damage response alterations, with particular emphasis on circulating tumour DNA (ctDNA) as a marker of molecular residual disease, relapse risk and treatment response. Key evidence from ctDNA-guided perioperative and adjuvant studies, including IMvigor011, TOMBOLA and related prospective work, will be discussed as examples of how serial molecular testing may support treatment escalation and de-escalation. Building on this framework, the talk will address how biomarker concepts are entering the bladder preservation field. Plasma ctDNA and urine tumour DNA may provide complementary information: plasma analyses can inform systemic molecular residual disease and metastatic risk, whereas urine-based assays may be particularly relevant for local residual disease, intravesical recurrence and response to organ-preserving treatment. Emerging translational data from bladder-sparing trials will be highlighted. Finally, the presentation will discuss how these approaches can be moved towards clinical implementation, and what evidence is needed before biomarkers can guide decisions about treatment intensification, de-escalation or bladder preservation. 5342 Next generation radiotherapy: Reinventing organ preservation in an era of systemic therapy (including adaptive RT & RT + IO combo) Peter Hoskin Cancer centre, Mount Vernon Hospital, Northwood, United Kingdom. Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom Organ preservation with good function is an important goal in the radical treatment of cancer. Trimodality Therapy (TMT) incorporating maximal TURBT, radiotherapy and a radiosensitiser has become an accepted standard of care for muscle invasive bladder cancer with case control and propensity matched studies showing equivalence to radical cystectomy. The therapeutic value of TURBT is now controversial. In the landmark phase 3 trials of chemoradiation (BC2001) and hypoxia modification (BCON) only 50% of patients received a complete TURBT and no
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