Radiotherapy for carcinoma of the bladder - A review

Carcinoma of the bladder (CaB) is a common and important tumor in North Ame rica and Western Europe. There has been a steady increase in the incidence of CaB during the past 25 years in both of these regions with a simultaneou s decrease in the mortality rates. The decrease in mortality is primarily d ue to an earlier diagnosis and the availability of more effective therapeut ic interventions resulting from major advances in surgery and a wide use of multimodality bladder preservation therapy. The use of radiotherapy in the management of muscle-invasive CaB has undergone a major evolution. Externa l beam radiotherapy alone is used infrequently in carefully selected patien ts. The same applies to the use of preoperative irradiation. Brachytherapy alone or combined with external beam radiotherapy has been used successfull y in Europe but is used infrequently in North America. External beam radiot herapy is an essential component of a multimodality therapy consisting of c ytoreductive surgery via transurethral resection of a bladder tumor followe d by a planned combination of radiotherapy and chemotherapy. The outcomes o f this bladder preservation therapy are similar to those reported in a like patient population treated with radical cystectomy. The main benefit of co nservatively treated patients is functioning bladder in about 50% of those receiving conservative therapy. Radiotherapy alone or in a combination with chemotherapy remains an important and effective palliative therapy for pat ients with recurrent and/or metastatic CaB. Current research efforts are di rected toward a better identification of important pretreatment risk factor s predicting failure thus helping in a more optimal selection of patients w ho would benefit most from radical cystectomy or from the application of bl adder preservation therapy.