Radiation therapy in regionally advanced bladder cancer.

In conclusion, for patients undergoing bladder preservation, conventional external radiation therapy can no longer be recommended as a curative single modality. The usefulness of prognostic indicators, such as radiation responsiveness and tumor morphology, will have to be evaluated in light of newer treatment regimens. Patients should receive external radiation only if other therapies such as hyperfractionation, brachytherapy, intraoperative electrons, or combined chemotherapy and radiation therapy are unavailable or unable to be tolerated. Patients undergoing a planned cystectomy should receive preoperative radiation therapy until such time as neoadjuvant chemotherapy has been proved more or equally effective.