The role of palliative radiotherapy in bladder cancer: a narrative review

Bladder cancer is the 6th most common cancer worldwide and contributes significant excess mortality and morbidity. It often presents at a late stage when it is incurable, and the prognosis is poor. The local symptoms of bladder cancer-including haematuria, dysuria, frequency, nocturia and pain, have significant effects on quality of life and may require frequent inpatient admissions. As a palliative treatment, radiotherapy can be uniquely useful in providing targeted long term symptomatic control, although this must be balanced against the potential of causing toxicity. A variety of radiotherapy protocols have been developed for managing these symptoms. The results of several studies show that radiotherapy delivered in a hypofractionated regime (21 Gy in 3 fractions) can provide relief of these symptoms within a few weeks. Other commonly used regimes include 35 Gy in 10 fractions, 30 Gy in 5 fractions, a once weekly 36 Gy in 6 fractions, and a single 8 Gy fraction. In the palliative setting symptom resolution lasts for the majority of the patients remaining lifespan. Benefit is particularly clear for symptomatic haematuria and in these patients even single doses may provide rapid benefit. To maximise benefit from radiotherapy, studies are urgently needed to better estimate the prognosis of patients presenting with bladder cancer.