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Radiation Therapy in Bladder Cancer

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Radiation Oncology

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Abstract

Urinary bladder carcinoma is one of the most frequent malignant tumors. For nonmuscle-invasive disease (Ta, Tis, T1), the aim is to reduce recurrences and prevent progression to more advanced stages by transurethral resection of the tumor (TUR-B) with or without instillation therapy with mitomycin C or Bacille Calmette-Guérin (BCG). Standard surgical treatment for muscle-invasive cancer (≥T2) is radical cystectomy with pelvic lymphadenectomy supplemented with neoadjuvant/adjuvant cisplatin-based chemotherapy for those patients able to receive it. As a valid alternative to radical surgery for muscle-invasive disease, organ-preserving, multimodal management, consisting of initial TUR-B followed by concurrent chemoradiotherapy (CRT), has been established. Radiosensitization should be cisplatin-based or with a combination of 5-fluorouracil and mitomycin C. With this approach, complete response rates after TUR-B and CRT are reached between 60% and 90% of patients as well as 5-year survival rates between 40% and 75%, with preservation of the bladder in approximately 80% of surviving patients. Ideal patients for the organ-preserving approach are those with early tumors (cT2/3aN0) in whom initial TUR-B leads to complete tumor resection (R0). Cisplatin-based combination chemotherapy has been the mainstay for the systemic treatment of metastatic bladder cancer. Immunotherapy in the form of checkpoint inhibitors is now a promising new treatment approach for metastatic refractory disease.

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Authors and Affiliations

  1. Department of Radiotherapy and Oncology, Goethe-University of Frankfurt, Frankfurt, Germany

    Claus Rödel & Nikolaos Tselis

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  1. Claus Rödel
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  2. Nikolaos Tselis
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Correspondence to Claus Rödel .

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Editors and Affiliations

  1. Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany

    Frederik Wenz

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Rödel, C., Tselis, N. (2018). Radiation Therapy in Bladder Cancer. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_39-1

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  • DOI: https://doi.org/10.1007/978-3-319-52619-5_39-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52619-5

  • Online ISBN: 978-3-319-52619-5

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