Expanding Role of SBRT in Primary Bladder Cancer – Is it Ready for Prime Time?

Muscle invasive bladder cancer (MIBC) is treated by either radical cystectomy followed by adjuvant therapy or bladder preservation approach with radical chemoradiation (CTRT) after maximal safe resection of bladder tumor (TURBT). However, a substantial proportion of patients either develop toxicities or are in poor performance status for radical CTRT. MIBC on the other hand remains extremely symptomatic with pain, bleeding and eventually irritative/obstructive bladder symptoms and disease progression. Stereotactic body radiotherapy (SBRT) evolved as a curative option in many disease sites and gained popularity as a curative intent treatment in oligometastatic disease scenarios. SBRT targeting macroscopic bladder tumor with shorter treatment course, optimisation of symptom (eventual tumor) control and better compliance led to exciting albeit few publications. This review will highlight role of SBRT in primary bladder cancer.