New bladder cancer guideline highlights bladder-preserving treatment options

A new clinical guideline from ASTRO is putting bladder preservation, and the role of radiation therapy, more clearly into the conversation for people with bladder cancer.

For many people diagnosed with muscle-invasive bladder cancer, surgery to remove the bladder, known as a radical cystectomy, has traditionally been an important part of curative treatment. But a new clinical guideline from the American Society for Radiation Oncology (ASTRO) highlights another option for some patients: a bladder-preserving approach that combines surgery to remove the visible tumor, radiation therapy, and chemotherapy.

What is trimodal therapy?

The approach, called trimodal therapy (TMT), combines three treatments:

• Transurethral resection of the bladder tumor (TURBT) to remove as much of the tumor as possible
• Radiation therapy directed at the bladder
• Concurrent chemotherapy to help make the cancer cells more sensitive to radiation

According to ASTRO’s new guideline, TMT can be a curative alternative to radical cystectomy for appropriately selected people with muscle-invasive bladder cancer. The guideline specifically identifies factors that may make someone a better candidate for bladder preservation, including a solitary tumor smaller than 7 centimeters, predominant urothelial carcinoma, and the absence of extensive carcinoma in situ or hydronephrosis.

Importantly, bladder preservation doesn’t mean eliminating surgery or other treatments. Instead, it uses multiple treatments together, followed by close monitoring. People who receive TMT should have cystoscopic assessments after treatment and continued surveillance for recurrence.

Radiation therapy has a role beyond bladder preservation

The new guideline also emphasizes that radiation therapy can play a role at other points in bladder cancer care.

For people who have already had their bladder removed, ASTRO conditionally recommends postoperative radiation therapy for some patients at higher risk of cancer returning in the pelvic region. For example, this could include patients with cancer extending through the bladder wall, involved lymph nodes, or positive surgical margins.

Radiation can also be used to manage symptoms and control disease in people with advanced bladder cancer. For example, bladder-directed radiation may help relieve symptoms such as bleeding and pain. Radiation may also be considered for certain patients whose metastatic disease responds to systemic treatment.

What does this mean for patients?

The most important takeaway is that there may be more than one path through bladder cancer treatment. Whether bladder preservation is appropriate depends on factors such as the cancer’s stage and characteristics, as well as a patient’s overall health, previous treatments, and personal priorities.

ASTRO emphasizes multidisciplinary care and shared decision-making when considering these approaches. That means conversations among urologists, medical oncologists, radiation oncologists, and patients can be an important part of determining which treatment strategy is appropriate.

If you or someone you love has been diagnosed with muscle-invasive bladder cancer, consider asking your care team: “Am I a candidate for bladder-preserving trimodal therapy, and how does it compare with radical cystectomy in my situation?”

The answer will be individual to each patient, but the new ASTRO guideline makes clear that radiation therapy deserves a place in that conversation.

Disclaimer: The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Outcomes4Me is not acting as your caregiver, and any suggestions or guidance offered should not replace the advice of your healthcare provider or qualified medical professional. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding a medical condition.