Review of hypo-fractionated radiotherapy for localized muscle invasive bladder cancer

The most common treatment for non-metastatic muscle invasive bladder cancer (MIBC) is radical cystectomy with pelvic lymph node dissection. For selected patients, trimodal therapy (TMT) consisting in a maximal transurethral resection of the bladder, followed by a concurrent chemotherapy and radiotherapy, spread over 5 to 7 weeks, is considered as an acceptable option. We aimed to perform a systematic review to report the current results of curative hypo-fractionated radiotherapy in terms of oncological outcomes and toxicity. In total, 5 phase III and 13 phase II trials were retained. Our review shows that TMT using hypo-fractionated radiotherapy allows a 2-year recurrence free survival rate between 43% and 83%, a 5-year OS rate going from 36% to 58%. Less than 12% of late grade ≥3 gastro-intestinal toxicities and between 4 to 46% grade ≥3 genito-urinary late toxicities were observed. This approach must be evaluated with prospective trials including quality of life scales.