The case for radiotherapy with or without chemotherapy in high-risk superficial and muscle-invading bladder cancer

The standard treatment for superficial high-grade bladder cancer is transurethral resection with or without subsequent intravesical therapy. Although a few series have reported good local control rates for T1 tumors, using either external beam irradiation or brachytherapy, this does not represent the standard of care in the United States. External beam radiation may be attempted in patients whose tumors cannot be resected transurethrally and who refuse cystectomy. The case for radiotherapy with or without chemotherapy is far stronger in muscle-invading cancers. Overall survival rates around 50% have been reported in larger series from a number of major centers. Most of these 5-year survivors retain their native bladders. The bladder morbidity of such an approach is very low. There are several studies currently active to determine the most appropriate sequence and combination of drugs and radiation.