ABSTRACT
Introduction There is extensive experience using radiation, either alone or in combination with surgery or chemotherapy to treat muscle-invasive bladder cancer. The goal of radiation treatment is to eradicate the tumor while preserving the structure and function of the bladder and other surrounding normal tissues. The utility of radiation in treating cancer arises because of differences in the radiation response of tumors and normal tissues. In general, tumor cells are less able than normal cells to repair DNA damage produced by radiation. DNA and other intracellular damage from radiation induce downstream molecular events leading to cell death. Differences in the molecular and cellular radiation responses of malignant and normal tissues result in a favorable therapeutic ratio. The tumoricidal effects of carefully planned and delivered radiation treatment should outweigh the potential for serious toxicity to normal surrounding tissues. Advances in high-precision, image-guided radiotherapy, coupled with an improved understanding of bladder cancer radiobiology and specific targeting of molecular pathways that contribute to radiation resistance, have the potential to dramatically improve tumor control in bladder cancer patients while maintaining normal bladder function.
