Radiotherapy for the treatment of muscle-invasive bladder cancer

Bladder preservation based on trimodal therapy (TMT) is an option for muscle-invasive bladder cancer (MIBC) patients unwilling to undergo radical cystectomy (RC) or unfit for radical surgery. Although randomized studies are missing, numerous reprospective and prospective series showed that TMT offers satisfactory oncological outcomes, comparable to RC with or without chemotherapy, with salvage cystectomy being reserved for patients with incomplete response or local muscle-invasive relapse. Regarding the irradiation, the standard fractionation usually is of 1.8-2 Gy/fraction with the total irradiation dose to the whole bladder being approximately 55-66 Gy and 45-50 Gy to the pelvic lymph nodes. The recent advances in the radiotherapic field, such as the introduction of intensity modulated radiotherapy (IMRT) and the image guided radiotherapy (IGRT), have improved conformity of the radiation dose to the target volume and reduced the gastrointestinal and genitourinary toxicity. Based on the current literature TMT option should be discussed in highly selected patients motivated to preserve their urinary bladder.