Radiosensitisation strategies for the treatment of bladder cancer

More than 10,000 people a year are diagnosed with urinary bladder cancer in the UK. Over a third of these patients present with muscle invasive bladder cancer (MIBC), and require more intensive treatment than those with non-muscle invasive disease. Radical cystectomy, which involves removal of the bladder and distal ureters, and reconstruction of the urinary tract, has traditionally formed the mainstay of treatment for these patients. However, more recently multimodality therapy approaches have been developed as an alternative to cystectomy, with a view to bladder preservation and improved quality of life after treatment. Trimodality therapy (TMT) involves transurethral resection of bladder tumour, cisplatin-based neoadjuvant chemotherapy, followed by radiotherapy in combination with an appropriate radiosensitiser. Patients treated in this way have similar survival outcomes to those who undergo radical cystectomy. Indeed, guidelines now advocate TMT as a radical treatment option in patients with MIBC.

Several large clinical trials have demonstrated the importance of radiosensitising agents in addition to radiotherapy as part of TMT. Here, we describe radiosensitising regimens in use in the UK for patients with MIBC, and explore the mechanisms of action of these drugs to cause synergistic effects with radiotherapy. We also speculate on novel radiosensitisers that may become available for treatment of these patients in the future.

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