# The Promise of Radiotherapy in High-Risk Non-Muscle Invasive Bladder Cancer

## TL;DR

This review explores the potential of radiotherapy as a new treatment option for high-risk non-muscle invasive bladder cancer.

## Contribution

The paper highlights the emerging promise of radiotherapy for non-muscle invasive bladder cancer due to recent technological and biomarker advances.

## Key findings

- Radiotherapy is not currently used for non-muscle invasive bladder cancer but is effective in muscle invasive cases.
- Modern radiotherapy techniques reduce normal tissue damage and could outperform BCG or surgery.
- Combining radiotherapy with radiosensitisers and biomarkers may improve treatment outcomes.

## Abstract

Non-muscle invasive bladder cancer (NMIBC) is not currently treated with radiotherapy. However, other bladder cancers are successfully treated with radiotherapy. In this review, we discuss how NMIBC is treated currently and what the advantages and disadvantages of these treatments are. We summarise the recent developments in the treatment of NMIBC and highlight the promise of radiotherapy in this context. We then discuss future treatments for non-muscle invasive bladder cancer and how existing treatments can be made more effective.

Global shortages, toxicities, and high levels of incomplete treatment with Bacillus Calmette Guerin (BCG) for non-muscle invasive bladder cancer has resulted in increasing interest in alternative treatments. Radiotherapy is not the standard of care for non-muscle invasive bladder cancer (NMIBC), despite being routinely used in muscle invasive bladder cancer. Modern techniques and advances in technology mean that radiotherapy can be delivered with increased precision in reducing normal tissue damage. Developing novel biomarker approaches, together with combination approaches with radiosensitisers and other systemic treatments, means that radiotherapy could offer greater benefits than current treatments with BCG or surgery. This review summarises the current landscape and future potential of radiotherapy for high-risk NMIBC.