Radiation therapy can be given as curative- or palliative treatment.
The main prognostic factors considering the effect of radiation therapy are spread of tumor (T-stage), grade (low-grade or high-grade), level of hemoglobin in blood before treatment and the patient's general condition.
Curative radiation therapy
Curative radiation therapy may be given preoperatively, postoperatively or as radical treatment for patients with muscle-infiltrating cancer with not proven metastases to lymph nodes or distant metastases.
Preoperative radiation therapy is not included in any standard program, but is performed to reduce the tumor size and make full or partial removal of the bladder technically easier. This will also reduce the risk of spreading cancer cells during surgery and prevent the risk of establishing new tumors.
At local recurrence after cystectomy, radiation therapy may be considered, but as of today no studies show any gain of supplemental radiation therapy after cystectomy.
Curative radiation therapy may be considered by:
- small tumors with limited invasion into muscle (T2).
- cases where the patient's general condition indicates that the bladder cannot or should not be completely removed.
- in those cases where the patient does not want to remove the urinary bladder due to reduced quality of life.
For patients where the aim of radiation therapy is curative, tissue samples are taken from the tumor area after finishing the treatment. In Norway primarily external radiation therapy is used, brachytherapy is not common.
External radiation therapy is given on the basis of CT-based dose planning. Special considerations is necessary to reduce radiation against the bowel, bowel movements are also considered when the radiation field is planned. The treatment course is daily treatments with 2 Gy x 32, in other words a total dose of 64 Gy. In recent years it has often been attempted to provide cisplatin weekly as an adjunctive therapy in connection with radiation therapy. However, this requires good general condition and a good renal function.
Palliative radiation therapy
Radiation therapy with palliative intention may be offered to patients where the tumor is not technically available for surgery. The treatment will reduce the patient´s problems of bleeding and pain.
Technique and dose/number of treatments may vary based on the patient's condition and the tumor´s biological growth. Alternatively the course of treatment may be 2 Gy x 25, 3 Gy x 10, 4 Gy x 5 or 7 Gy x 3. For spreading tumors the palliative radiation therapy are varying depending on the location of the tumors and the purpose of treatment.