Current status of radiation therapy for bladder cancer.

The role of radiation therapy in the management of muscle-invasive bladder cancer has evolved tremendously over the past several decades. Early on, radiation therapy alone was utilized as the preferred method of bladder preservation. Unfortunately, the results with this approach have been suboptimal. More recently, several protocols have been developed using a combined modality approach with chemotherapy. This has opened the door once again to the concept of bladder conservation as a potentially equivalent approach to radical cystectomy. While it is unlikely that a randomized trial comparing radical cystectomy with bladder preservation and chemoradiotherapy will be performed, the latter treatment strategy is gaining more support among practitioners. In selected patients with muscle-invasive bladder cancer, bladder-preservation approaches can achieve high rates of complete response, acceptable disease control and excellent long-term bladder function. The key to success for such programs is the careful selection of patients with favorable clinical features and close monitoring of the treatment response during therapy. Aggressive transurethral resection of bladder tumor to debulk disease and early referral for cystectomy in nonresponding patients are also highly critical for a successful outcome.