ASTRO Unveils Clinical Guideline for Radiation Therapy in Bladder Cancer
The American Society for Radiation Oncology (ASTRO) has presented its inaugural clinical guideline on the use of radiation therapy in bladder cancer treatment. This guideline, published in Practical Radiation Oncology, emphasizes trimodal therapy as an option for bladder preservation in muscle-invasive bladder cancer. It serves as an alternative to radical cystectomy and offers recommendations for radiation post-surgery and in cases of metastatic disease.
Bladder cancer remains a significant health issue, ranking as the fifth most diagnosed cancer among men in the United States. Although its incidence has seen a decline, projections indicate that approximately 85,000 U.S. adults could be diagnosed in 2026, with an estimated 18,000 fatalities.
Radical cystectomy has been the go-to treatment strategy for muscle-invasive bladder cancer, often combined with systemic therapies. However, this may not be suitable for all patients due to various health conditions or personal preference for preserving the bladder. Trimodal therapy, involving the maximal resection of the bladder tumor followed by chemoradiation, emerges as a viable alternative for selected patients. Studies have shown that outcomes with trimodal therapy can mirror those of radical cystectomy, while maintaining bladder function.
"Bladder preservation should be presented as a curative treatment option alongside radical cystectomy for appropriately selected patients with muscle-invasive bladder cancer," stated Dr. Jason A. Efstathiou, Chair of the Guideline Task Force. Similarly, Dr. Leslie K. Ballas, Vice Chair of the Task Force, highlighted the broader utility of radiation therapy in enhancing local control post-cystectomy and managing symptoms in advanced disease.
Key recommendations include:
Bladder Preservation: For patients with cT2-4aN0M0 muscle-invasive bladder cancer, trimodal therapy—including maximal resection followed by chemoradiation—is advised. Suitable cases involve solitary tumors smaller than 7 cm, predominantly urothelial carcinoma, and certain other conditions. Post-treatment, ongoing surveillance through cystoscopy is encouraged.
Post-Cystectomy Radiation Therapy: Adjuvant radiation is suggested for patients facing higher recurrence risks post-surgery, particularly those with advanced disease stages, involved lymph nodes, or positive margins.
Advanced and Symptomatic Disease: For symptom control in metastatic disease, bladder-directed radiation is endorsed, as is radiation therapy for specific metastatic sites if systemic therapy yields a response.
The guidelines also address the challenges in accessing multidisciplinary evaluations and bladder-preserving treatments, especially in underserved areas. There is an appeal for improved access to these treatments and the inclusion of traditionally underrepresented demographics in bladder cancer research.
The guideline was formulated by a multidisciplinary team comprising experts across various oncological specialties and was developed with inputs from the American Society of Clinical Oncology (ASCO), the European Association of Urology, and the European Society for Radiotherapy and Oncology. The European Association of Urology has endorsed the guideline.