Radiotherapy for carcinoma of the bladder: a review

Area of Science:

• Oncology
• Urology
• Radiation Oncology

Background:

• Bladder carcinoma (CaB) incidence has increased in North America and Western Europe.
• Mortality rates for CaB have decreased due to earlier diagnosis and improved treatments.
• Multimodality bladder preservation therapy has advanced significantly.

Purpose of the Study:

• To review the evolving role of radiotherapy in managing muscle-invasive bladder cancer.
• To discuss bladder preservation strategies and their outcomes compared to radical cystectomy.
• To highlight current research in identifying predictive factors for treatment selection.

Main Methods:

• Review of radiotherapy techniques in bladder cancer management, including external beam, brachytherapy, and preoperative irradiation.
• Analysis of multimodality bladder preservation therapy combining transurethral resection, radiotherapy, and chemotherapy.
• Comparison of outcomes between bladder preservation and radical cystectomy.

Main Results:

• External beam radiotherapy is often part of multimodality therapy for muscle-invasive CaB.
• Bladder preservation therapy yields outcomes comparable to radical cystectomy, with a functioning bladder in ~50% of patients.
• Radiotherapy remains crucial for palliative care in recurrent or metastatic CaB.

Conclusions:

• Multimodality bladder preservation therapy is an effective alternative to radical cystectomy for selected bladder cancer patients.
• Identifying pretreatment risk factors is key to optimizing treatment selection between radical cystectomy and bladder preservation.
• Radiotherapy plays a vital role in both curative and palliative settings for bladder cancer.