What are the indications for radiation therapy in bladder cancer?
Radiotherapy is indicated:
- As a treatment for certain forms of bladder cancer after conservative bladder surgery such as trans-urethral bladder tumor resection;
- For the treatment of infiltrating bladder tumours in patients who have not undergone surgery or who have refused surgery;
- As an attack treatment in advanced bladder cancer;
- As a treatment for some of the consequences of advanced bladder cancer.
Radiotherapy is often associated with chemotherapy. Chemotherapy drugs administered sensitize target tissues to radiation effects. This is a concomitant radiochemotherapy protocol.
How is radiotherapy administered?
In bladder cancer, X-rays are delivered as external radiation therapy.
Radiation focused on the tumour from a source of radiation external to the patient’s body.
Before irradiation itself, the radiotherapist, using a scanner, will calculate the necessary doses and their fractionation mode by multiplying the entry points of the rays in order to limit the side effects.
This simulation, which is a prelude to the radiotherapy itself, is often guided by images of bladder imaging in sections, CT or MRI.
The delivery mode of irradiation itself is similar to that of a conventional X-ray, but irradiation delivers a much larger dose of radiation.
The irradiation itself is painless. Each session lasts a few minutes, but the preparation of the session is longer than the irradiation itself.
Usually, irradiation is delivered for several weeks at a rate of 5 days/week, but there may be variations depending on the radiotherapist’s habits.
Possible side effects of irradiation
The possible side effects of irradiation depend on the doses administered and the anatomical location of the irradiated site.
It may be about:
- Radial dermatitis, which is the equivalent of skin burns;
- Nausea and vomiting;
- Signs of bladder irritation such as burns or pain at urination or the need to urinate more often or the presence of blood in the urine;
- Reduction of blood lines, with fatigue caused by anemia, increased hemorrhagic risks due to a decrease in platelet counts or increased infectious risks due to a decrease in white blood cell counts.
These side effects usually retrocede after the end of treatment although in some people they may persist longer. Like, for example:
Development of urinary incontinence following bladder irradiation;
Radical cystitis by permanent alteration of the bladder wall with eventually painful hematuria or urination.