Radiation therapy combined with limited surgery and chemotherapy can cure muscle-invasive bladder cancer, according to the American Society for Radiation Oncology’s first practice guideline on radiotherapy for the disease.
Published September 16 in Practical Radiation Oncology, the recommendations support trimodal therapy as an alternative to bladder removal in selected patients and provide guidance on the use of radiation therapy after surgery and for patients with metastatic or symptomatic disease.
“Bladder preservation should be presented as a curative treatment option alongside radical cystectomy for appropriately selected patients with muscle-invasive bladder cancer,” said guideline task force chair Jason A. Efstathiou, MD, PhD, of Mass General Brigham Cancer Institute in Boston, in an ASTRO news release.
Bladder cancer is estimated to affect 85,000 U.S. adults in 2026, the fifth most commonly diagnosed cancer in men, and will account for roughly 18,000 deaths, ASTRO said. Surgical removal of the bladder has long been a standard curative treatment for invasive bladder cancer and typically requires creating a new urinary pathway, ASTRO noted. Some patients are ineligible because of frailty or other health conditions, while others prefer to preserve their organ, the society added.
According to the guideline, favorable selection features include a solitary tumor smaller than 7 centimeters, predominant urothelial carcinoma, and no extensive carcinoma in situ or hydronephrosis.
Adjuvant radiation is conditionally recommended for patients with pT3-4 disease, positive lymph nodes, or positive surgical margins after cystectomy, the society added. Bladder-directed radiation is recommended for patients with advanced or symptomatic disease not receiving curative treatment.
The recommendations are based on a systematic review of research published from 2009 through 2024 and developed in collaboration with the American Society of Clinical Oncology, the European Association of Urology, and the European Society for Radiotherapy and Oncology.
The guideline also cover radiation treatment planning and delivery, including recommended dose and fractionation schedules and guidance on intensity-modulated radiation therapy with daily image guidance, ASTRO said. The task force also identified persistent disparities in access to bladder-preserving treatment in underserved and rural communities and called for greater inclusion of historically underrepresented populations in bladder cancer research.
The full guideline is available here.