title: [Critical vision in the treatment of invasive vesical cancer with ionizing radiation].
abstract: OBJECTIVE
  To review the treatment of invasive bladder cancer with ionizing radiation.
  
  
  METHODS
  Patient selection criteria, prognostic factors, treatment of different tumor types with radiation using different strategies alone or in combination with chemotherapy are analyzed in the literature.
  
  
  CONCLUSIONS
  The role of radiotherapy in the treatment of invasive carcinoma of the bladder is crucial: 1) preoperative radiotherapy in combination with radical surgery achieves results comparable with those of cystectomy in terms of survival and a higher local control rate; 2) used in combination with cisplatin post-TUR, irradiation is highly effective for local control of the tumor and bladder preservation, with complete remission rates ranging from 60-70%, which are higher than those of radical cystectomy; 3) in this latter therapeutic modality the effect of radiotherapy is dose-related and is influenced by factors such as tumor size, presence or absence of urinary obstruction, presence of multiple lesions on the bladder wall and extravesical spread. Over the last few years, a number of therapeutic procedures have been developed, which can improve the previously mentioned results when used appropriately. Among these are hyperfractionation, accelerated irradiation and concomitant radio and chemotherapy. Studies to determine tumor radiosensitivity (Fs2/a) and the use of gene therapy could enhance the tumor control rate in the future, although a system for the selection on patients for conservative or multilating treatment based on clinical, clinicopathological and scientific criteria will have to be developed. Finally, the use of special techniques, particularly brachytherapy and intraoperative irradiation, in combination with external radiotherapy has achieved excellent results (high local control and survival rates) in certain situations, basically in single/small-sized tumours.
authors.affiliation: Servicio de Radioterapia, Hospital Clinico Universitario, Granada, España.
authors.forename: V
authors.initials: V
authors.lastname: Pedraza
authors.forename: J
authors.initials: J
authors.lastname: Cueto
authors.forename: I
authors.initials: I
authors.lastname: Castillo
authors.forename: C
authors.initials: C
authors.lastname: Gonzalo
authors.forename: M J
authors.initials: MJ
authors.lastname: Romero
authors.forename: A
authors.initials: A
authors.lastname: Zuluaga
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy*