Radiation therapy for muscle-invasive bladder cancer: Treatment planning and delivery in the 21st century

Advances in radiation treatment planning, verification, and delivery provide a means to optimize radiation treatment for bladder cancer and overcome difficulties which have previously limited the success of this treatment. They offer the opportunity to enhance the therapeutic ratio by reducing the volume of normal tissue irradiated and by increasing radiation dose or using more intensive fractionation and synchronous chemotherapy regimes. In this review, we aim to present a practical overview of radiation protocols for bladder cancer, covering issues relating to patient selection, choice of target volumes, verification, dose, and fractionation. Alternative methods of improving treatment accuracy such as image-guided radiotherapy and intensity modulated radiotherapy are also discussed.