Systematic review and meta-analysis of radiation therapy for high-risk non-muscle invasive bladder cancer

Bladder sparing by short-course radiotherapy combined with toripalimab in high-risk/extremely high-risk non-muscle invasive bladder cancer (HOPE-04): study protocol for a single-arm, prospective, phase II trial

“…The study demonstrated radiotherapy would be a bladder preservation treatment for NMIBC, which needed further prospective trials to verify. 10 In recent years, immunotherapy has revolutionised the treatment of urothelial bladder cancer. Based on the KEYNOTE-057 (NCT02625961) study results of cohort A, pembrolizumab is recommended by National Comprehensive Cancer Network (NCCN) guidelines as a non-cystectomy option for patients with NMIBC with BCG unresponsive, especially for patients with CIS.…”

“…Open access on a systematic review and meta-analysis of radiation therapy for high-risk NMIBC, the bladder radiation dose is approximately 50 Gy, which is lower than that of MIBC. 10 Hence, the effect of 5×5 Gy and 9-18 Gy in 3-6 fractions combination is supposed for bladder preserving in NMIBC. And the boost volume is based on the primary lesion of imaging before TURBT.…”

“…The study demonstrated radiotherapy would be a bladder preservation treatment for NMIBC, which needed further prospective trials to verify. 10 …”

“…Besides, based on the systematic review and meta-analysis of radiation therapy for high-risk NMIBC, the bladder radiation dose was approximately 50 Gy, which was lower than that of MIBC. 10 Hence, a focal tumour bed boost of 9–18 Gy in 3–6 fractions will be given sequentially after the whole bladder radiation to ensure the dose is enough for bladder cancer.…”

Recommendations for planning and delivery of radical radiotherapy for localized urothelial carcinoma of the bladder

“…Besides, patients eligible for trimodal therapy must have an adequate bladder function; no consensus exists on this criteria, but this may include: bladder capacity >200 ml, no significant incontinence ( 1 pad/day), no significant irritative symptoms (no urgency, no daily pollakiuria, nocturnal pollakiuria 2/night) and no significant dysuria (IPSS score <8). Notably, the role of trimodal therapy for patients with high-risk non-muscle-invasive bladder cancer or with history of BCG failure remains controversial, and this strategy cannot be recommended in routine for these patients for now [17]. In any case, the feasibility of trimodal therapy should be validated during a multidisciplinary tumor board, involving urologists, medical oncologists, pathologists, radiologists and radiation oncologists.…”