Will Bladder Preservation Become More Common in the Future?

Considerations for Radiation

• Favored for patients who are frail or not great surgical candidates
• For selected patients who don’t have multi-focal disease or high-risk features
• Studies are now looking at radiation plus immunotherapy, and at chemotherapy as a radiosensitizer

“For localized bladder cancer patients who have muscle invasive disease, a lot of departments across the country really do favor surgery,” Dr. Jeannie Hoffman-Censits, medical oncologist and bladder cancer specialist at Johns Hopkins, tells SurvivorNet Connect. Radiation has long been an option for selected patients who don’t have multi-focal disease, “who don’t have certain high-risk features. But oftentimes radiation has been more used for patients who were maybe frail, not great surgical candidates, because radical cystectomy is a big and morbid surgery at times.”

Dr. Hoffman-Censits says that there are now multiple large studies going on, including one sponsored by the Southwest Oncology Group (SWOG) looking at the use of radiation. “Both with chemotherapy as a radiosensitizer as well as incorporating immunotherapy,” she says.

One unique study, she adds, is looking at patients with locally advanced lymph node-positive disease to see how chemotherapy combined with immunotherapy works in that space. “That’s a complicated group of patients to treat,” she says. “They don’t always meet metastatic criteria because they don’t have tumor present in visceral sites like the lung, liver, or bones. But if they have localized disease with regional adenopathy, we all grapple with what’s the right thing to do for these patients.”