ASTRO Issues Guidance for Use of Radiation Therapy in Bladder Cancer

FRIDAY, Sept. 18, 2026 (HealthDay News) — Recommendations are presented for the use of radiation therapy (RT) in bladder cancer in a clinical practice guideline issued by the American Society for Radiation Oncology and published online Sept. 15 in Practical Radiation Oncology.

Leslie K. Ballas, M.D., from Cedars Sinai in Los Angeles, and colleagues developed evidence-based recommendations addressing the indications for RT for bladder cancer in different clinical settings.

The authors encourage multidisciplinary evaluation for all patients. Trimodal therapy (TMT) is an alternative to radical cystectomy for select patients with cT2-4aN0M0 muscle-invasive bladder cancer. There is a recommendation for concurrent radiosensitizing systemic therapy with TMT; for patients at higher risk for distant progression, neoadjuvant or induction systemic therapy is recommended. RT is recommended to the whole bladder at full dose or to an uninvolved bladder at a reduced dose with a partial tumor boost; based on tumor characteristics, elective nodal RT is conditionally recommended. Adjuvant RT is conditionally recommended for locoregional control for patients with urothelial carcinoma who have (y)pT3-4 or (y)pN+ disease or positive margins postcystectomy. Intensity-modulated RT is recommended with daily image guidance. Bladder-directed RT is recommended for local control and/or palliation for patients with high-burden metastatic and locally symptomatic disease or locoregional disease managed with noncurative intent.

“The recommendations clarify when radiation therapy may improve local control after cystectomy and how it can be used to relieve or prevent symptoms for patients with advanced disease, giving multidisciplinary teams a clear framework to integrate radiation throughout bladder cancer care,” Ballas said in a statement.

Several authors disclosed ties to the pharmaceutical industry.

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