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News
ASTRO just released its first-ever guidelines on radiation therapy for bladder cancer, and they cover a lot of ground. The guidelines back trimodal therapy (TMT) — tumor resection plus chemoradiation — as a bladder-sparing alternative to surgery for select patients, and even extend that option to some with recurrent non-muscle invasive disease. Coverage also spans palliative radiation, post-surgery adjuvant RT, and integrating radiation with immunotherapy.
The American Society for Radiation Oncology (ASTRO) has published its first-ever clinical practice guideline dedicated to radiation therapy (RT) for bladder cancer, filling a long-standing gap in specialty-specific guidance. Published in Practical Radiation Oncology and endorsed by the European Association of Urology, the guideline was developed by a multidisciplinary task force of radiation, medical, and urologic oncologists, a medical physicist, and a patient representative.
At its core, ASTRO strongly endorses trimodal therapy (TMT) — maximal transurethral tumor resection followed by chemoradiation — as a curative, bladder-preserving alternative to cystectomy for select patients with muscle-invasive bladder cancer (MIBC). In a notable extension, the guidelines also conditionally recommend TMT for patients with recurrent, high-grade non-muscle invasive bladder cancer (cT1N0M0) who have exhausted other options and decline or cannot undergo surgery — a move supported by a promising 37-patient trial.
Key Takeaways:
Why it matters: These guidelines give clinicians a comprehensive, evidence-based roadmap for using radiation across the full spectrum of bladder cancer — from early-stage bladder preservation to metastatic palliation — helping standardize care and expand options for patients who are not surgical candidates.
