The role of radiation therapy in the management of transitional cell carcinoma of the bladder.

The advantage of radical radiation therapy is that a proportion of patients will be cured while preserving normal bladder and sexual function. In most solid tumors, radiation therapy results in a local control rate inferior to that obtained by surgery, and this is also true in bladder cancer. Thus, efforts to preserve bladder function are likely to result in a lower local control rate than that achieved by cystectomy, and even if XRT achieved a 100% response rate, it cannot be expected to eliminate the risk of new tumor formation. Because cystectomy results in the loss of normal urinary bladder function and has only limited ability to cure, radiation remains an important therapeutic option in patients with bladder cancer. However, the question of whether radiation with an option of cystectomy for salvage would yield results comparable to those obtained by cystectomy has not been adequately answered. Most radiation oncologists agree that the use of radical radiation in patients with little or no chance of local control is inappropriate. Therefore, attempts at selection of responders, based on either clinical or biologic pretreatment parameters, are being investigated. Radical radiation therapy currently achieves a 50% complete response rate; thus, a large number of patients are potentially subjected to the morbidity of both modalities. Patients who have a small chance of achieving local control with XRT or who are known to be at risk for the rapid development of further bladder tumors (therefore unlikely to preserve their bladder for a significant time) are better served by primary cystectomy. Some patients prefer surgical treatment because it is decisive and quick; any attempts at bladder preservation potentially result in a lengthy treatment. Ideally, bladder sparing with XRT should be reserved for patients who are motivated to preserve normal bladder function and, therefore, patients should be involved in the decision regarding the choice of primary management. Although most patients embrace the opportunity for bladder preservation, they are frequently dissuaded from radiotherapy by the poor prospect of achieving local control and the risks of late complications.(ABSTRACT TRUNCATED AT 400 WORDS)