ASTRO publishes its 1st clinical guidelines on radiation therapy for bladder cancer
A new clinical practice guideline from the American Society for Radiation Oncology (ASTRO) supports the use of bladder-preserving trimodal therapy as a curative alternative to removal for select patients with muscle-invasive bladder cancer.
Radical cystectomy has long been a standard curative treatment for muscle-invasive bladder cancer, but the procedure requires removal of the bladder and creation of an alternative route for urine. The new guideline suggests that selected patients can instead undergo trimodal therapy, combining maximal transurethral resection of the tumor with radiation therapy and concurrent chemotherapy.
The guideline is ASTRO’s first focused specifically on the role of radiation therapy across bladder cancer care. It provides recommendations for postoperative radiation and the management of advanced or symptomatic disease.
“The role of radiation therapy in bladder cancer extends well beyond bladder preservation,” guideline task force vice chair Leslie K. Ballas, MD, a radiation oncologist at Los Angeles-based Cedars-Sinai, said in a news release on the guidance. “The recommendations clarify when radiation therapy may improve local control after cystectomy and how it can be used to relieve or prevent symptoms for patients with advanced disease, giving multidisciplinary teams a clear framework to integrate radiation throughout bladder cancer care.”
Based on the new recommendations, favorable candidates for bladder preservation include patients with cT2-4aN0M0 disease who have a solitary tumor smaller than 7 centimeters, predominant urothelial carcinoma and no extensive carcinoma in situ or hydronephrosis. Patients should undergo cystoscopic evaluation following treatment and continued surveillance for recurrence. The guideline also conditionally recommends postoperative radiation for patients at elevated risk of locoregional recurrence following cystectomy, including those with pT3-4 disease, involved lymph nodes or positive surgical margins.
For patients with advanced disease, bladder-directed radiation can be used to control tumors or relieve symptoms such as bleeding and pain. Radiation to limited metastatic sites also may be considered in select patients who respond to systemic therapy, while bladder radiation is not recommended for those with asymptomatic, high-burden metastatic disease.
For treatment delivery, the guideline recommends intensity-modulated radiation therapy with daily image guidance; it also provides recommendations on dose, fractionation, target volumes and when to boost the primary tumor or include pelvic lymph nodes.
The recommendations were developed by a multidisciplinary task force and are based on a systematic review of literature published from 2009 through 2024. The guideline was developed with the American Society of Clinical Oncology, European Association of Urology and European Society for Radiotherapy and Oncology and was endorsed by the EAU.
For the detailed guidelines, click here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.