The role of palliative radiotherapy in bladder cancer: a narrative review

Abstract

Bladder cancer is the 6 th most common cancer worldwide and contributes significant excess mortality and morbidity. It often presents at a late stage when it is incurable, and the prognosis is poor.The local symptoms of bladder cancer-including haematuria, dysuria, frequency, nocturia and pain, have significant effects on quality of life and may require frequent inpatient admissions. As a palliative treatment, radiotherapy can be uniquely useful in providing targeted long term symptomatic control, although this must be balanced against the potential of causing toxicity. A variety of radiotherapy protocols have been developed for managing these symptoms. The results of several studies show that radiotherapy delivered in a hypofractionated regime (21 Gy in 3 fractions) can provide relief of these symptoms within a few weeks.Other commonly used regimes include 35 Gy in 10 fractions, 30 Gy in 5 fractions, a once weekly 36 Gy in 6 fractions, and a single 8 Gy fraction. In the palliative setting symptom resolution lasts for the majority of the patients remaining lifespan. Benefit is particularly clear for symptomatic haematuria and in these patients even single doses may provide rapid benefit. To maximise benefit from radiotherapy, studies are urgently needed to better estimate the prognosis of patients presenting with bladder cancer.

Is there a role for metastasis-directed therapy in bladder cancer?

“…For instance, Franzese et al [22] documented only grade 1 acute and long-term toxicities in their cohort, and the concurrent use of SBRT during systemic therapy in 23% of patients demonstrated the potential for a safe combination. This aligns with Bertucci et al 's [25] findings, suggesting that adverse events related to chemotherapy were comparable between groups receiving chemotherapy alone and those receiving both radiation and chemotherapy. Considering these findings, radiotherapy can be considered a well tolerated option for MDT.…”

“…Historically, the role of radiotherapy in BCa was predominantly palliative [25]; however, the advent of the oligometastatic concept has redefined this role in metastatic disease, offering a potentially curative approach. The SABR-COMET [26] and ORIOLE [27] phase II randomized trials investigated the role of metastasis-directed radiation therapy (MDRT) in various metastatic malignancies, such as prostate and breast cancers, showcasing its impact on enhancing oncologic outcomes.…”

The Use of Hospital Services by Patients With Muscle Invasive Bladder Cancer in the Last Year of Life: Identifying the Areas to Improve Care

“…Haematuria affects nearly a third of patients with MIBC and can necessitate admission due to either anaemia or clot retention [ 9 ]. These patients are often admitted for catheterisation, bladder washout, and irrigation as well as blood transfusion, if necessary.…”

EZH2 targeting to improve the sensitivity of acquired radio-resistance bladder cancer cells

“…Therefore, the bladder-sparing palliative therapies are commonly applied in the treatment of BCa, including radiotherapy, chemotherapy, immunotherapy, and close supportive medical care to alleviate symptom burden. Nowadays, high-precision 3D imaging guided radiotherapy greatly optimizes identification of the target volume sand surrounding at organs at risk (OARs) and minimize the side effects from dosing to other local organs [17] . Therefore, radiotherapy has been more and more widely used in BCa treatment.…”