Radiotherapy in bladder cancer

In the present review, we have evaluated the outcome of radiotherapy in pat ients with bladder cancer. The exact value of radical radiotherapy is diffi cult to establish because changes in treatment techniques and selection of patients have biased the results. The 5-year survival rates are reported to be 35-71% in T1 tumors, 27-59% in T2 tumors, 10-38% in T3 tumors and 0-16% in T4 tumors. Several other factors, like performance status and hemoglobi n level, are important for the outcome. Morbidity of radical radiotherapy d epends on several treatment and patient related factors, but 50-75% experie nce acute intestinal or urological symptoms and 10-20% may develop severe l ate toxicity, depending on the kind of registration. The importance of fiel d size or overall treatment time cannot be established from available data. Hyperfractionation with dose escalation has proven effective in one study. Preoperative radiotherapy with cystectomy has not proven better than cyste ctomy alone or better than radiotherapy alone. The addition of systemic che motherapy has increased disease-free survival, but has not significantly re duced the rate of distant metastases or improved overall survival. Presently, the standard radiation regimen is a conventional dose and fracti onation schedule to a total dose of 60-66 Gy with a three- or four-field te chnique covering the bladder and tumor. The efficacy of additional irradiat ion of regional lymph nodes is questionable. New treatment possibilities wi th advanced techniques of radiotherapy, hyperfractionation and dose escalat ion and/or the addition of systemic chemotherapy may improve outcome. These options should be further explored in clinical trials. (C) 1999 Elsevier S cience Ireland Ltd. All rights reserved.