Table 3.
Overview of the Role of RT as Palliative Treatment in MIBC, as Recommend by the Consulted Guidelines
| Guideline* | Evidence/ Recommendation | Level/ Strength |
|---|---|---|
| Palliative radiotherapy | ||
| EAU | RT can also be used to stop bleeding from the tumour when local control cannot be achieved by transurethral manipulation because of extensive local tumour growth.5 | LE: 3 |
| Local recurrence: offer RT, chemotherapy and possibly surgery as options for treatment, either alone or in combination.5 | SR: Strong | |
| Distant recurrence: Offer chemotherapy as the first option, and consider metastasectomy or RT in case of unique metastasis site.5 | SR: Strong | |
| ESMO | Palliative RT can be offered for palliation (bleeding, pain).6 | III, C |
| NCCN | RT alone can also be considered as a subsequent-line therapy for patients with metastatic disease or local recurrence following cystectomy, especially in selected cases with regional only recurrence or with clinical symptoms.7 | LE: 2A |
| Subsequent-line therapy for metastatic disease or local recurrence includes CRT (if no previous RT), or RT.7 | LE: 2A | |
| Concurrent CRT or RT alone should be considered for local palliation in patients with metastatic disease.7 | LE: 2A | |
| NICE | Offer palliative hypofractionated RT to people with symptoms of haematuria, dysuria, urinary frequency or nocturia caused by advanced bladder cancer that is unsuitable for potentially curative treatment.8 | LE: very low-high |
| Consider hypofractionated RT or embolisation for people with intractable bleeding caused by incurable bladder cancer.8 | LE: very low | |
| Pelvic pain: Consider, in addition to best supportive care, 1 or more of the following to treat pelvic pain caused by incurable bladder cancer: -hypofractionated RT if the person has not had pelvic RT.8 | LE: very low | |
Notes: *Characteristics of the consulted guidelines, including the system used for evidence and recommendation grading, are summarized in Supplementary Table 1. No RT recommendations provided for the palliative MIBC setting by the AUA/ASCO/ASTRO/SUO guideline.
Abbreviations: AUA/ASCO/ASTRO/SUO, American Urological Association/American Society of Clinical Oncology/American Society of Radiation Oncology/Society of Urologic Oncology; CRT, chemoradiotherapy; EAU, European Association of Urology; ESMO, European Society of Medical Oncology; LE, level of evidence; MIBC, muscle-invasive bladder cancer; NCCN, National Comprehensive Cancer Network; NICE, National Institute for Health and Care Excellence; RT, radiotherapy; SR, strength rating.