A study of image-guided radiotherapy of bladder cancer based on lipiodol injection in the bladder wall

Acta Oncol. 2010 Oct;49(7):1109-15. doi: 10.3109/02841861003789491.


Purpose: We have tested a procedure of focal injection of the contrast medium Lipiodol as a fiducial marker for image-guided boost of the tumor in bladder cancer radiotherapy (RT). In this study, we have evaluated the feasibility and the safety of the method as well as the inter- and intra-fraction shift of the bladder tumor.

Materials and methods: Five patients with muscle invasive urinary bladder cancer were included in the study. Lipiodol was injected during flexible cystoscopy into the submucosa of the bladder wall at the periphery of the tumor or the post resection tumor-bed. Cone-beam CT (CBCT) scans were acquired daily throughout the course of RT.

Results: Lipiodol demarcation of the bladder tumor was feasible and safe with only a minimum of side effects related to the procedure. The Lipiodol spots were visible on CT and CBCT scans for the duration of the RT course. More than half of all the treatment fractions required a geometric shift of 5 mm or more to match on the Lipiodol spots. The mean intra-fraction shift (3D) of the tumor was 3 mm, largest in the anterior-posterior and cranial-caudal directions.

Conclusion: This study demonstrates that Lipiodol can be injected into the bladder mucosa and subsequently visualized on CT and CBCT as a fiducial marker. The relatively large inter-fraction shifts in the positions of Lipiodol spots compared to the intra-fraction movement indicates that image-guided RT based on radio-opaque markers is important for RT of the bladder cancer tumor.

Trial registration: ClinicalTrials.gov NCT00609843.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravesical
  • Carcinoma, Transitional Cell / diagnostic imaging*
  • Carcinoma, Transitional Cell / radiotherapy*
  • Cone-Beam Computed Tomography / adverse effects
  • Cone-Beam Computed Tomography / instrumentation
  • Cone-Beam Computed Tomography / methods*
  • Contrast Media / administration & dosage
  • Contrast Media / adverse effects
  • Cystoscopy
  • Ethiodized Oil / administration & dosage*
  • Ethiodized Oil / adverse effects
  • Feasibility Studies
  • Humans
  • Movement / physiology
  • Organ Size
  • Phantoms, Imaging
  • Radiotherapy Planning, Computer-Assisted / methods
  • Radiotherapy, Intensity-Modulated / methods
  • Urinary Bladder / diagnostic imaging
  • Urinary Bladder / drug effects
  • Urinary Bladder / pathology
  • Urinary Bladder / physiopathology
  • Urinary Bladder Neoplasms / diagnostic imaging*
  • Urinary Bladder Neoplasms / radiotherapy*


  • Contrast Media
  • Ethiodized Oil

Associated data

  • ClinicalTrials.gov/NCT00609843