Onkologie. 2025:19(2):84-90 | DOI: 10.36290/xon.2025.018

Radiotherapy as an organ-preserving approach in treating muscle-invasive bladder cancer

Martin Palkovský, Renata Soumarová

Onkologická klinika 3. LF UK a FNKV, Praha

Muscle-invasive bladder cancer (MIBC) has traditionally been treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RACE). Although trimodal therapy (TMT), involving maximal transurethral resection (TUR) and chemoradiotherapy (CRT), yields comparable results, it is not yet considered standard treatment. This paper analyses the results of recent studies and recommendations concerning TMT in the treatment of MIBC. Retrospective analyses suggest that TMT achieves metastasis-free survival (MFS) and disease-free survival (DFS) rates similar to those obtained by NAC with RACE. However, the lack of direct comparison of TMT and NAC plus RACE limits the implementation of TMT as a standard treatment method. Nevertheless, new recommendations recognise TMT as an equally valid alternative for patients with restricted eligibility for NAC or RACE, or for those who prefer bladder preservation. Novel strategies including immunotherapy show potential for improved outcomes. In conclusion, TMT is an effective organ-preserving procedure in selected patients with MIBC; however, the choice of treatment strategy requires a tailored approach and multidisciplinary collaboration.

Keywords: muscle-invasive bladder cancer, radiotherapy, chemoradiotherapy, trimodal therapy, organ-preserving treatment.

Accepted: April 25, 2025; Published: May 2, 2025  Show citation