Chemoradiotherapy for bladder cancer

Chemoradiotherapy means having chemotherapy and radiotherapy treatment together. You might have chemoradiotherapy instead of an operation to remove your bladder Open a glossary item.

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. Radiotherapy uses high energy x-rays Open a glossary item to kill cancer cells.

The chemotherapy helps the radiotherapy to work better. 

When do you have it?

Your doctor might suggest you have radiotherapy Open a glossary item as your main treatment instead of surgery Open a glossary item. You usually have radiotherapy with chemotherapy. But radiotherapy is not a suitable treatment for everyone. Your doctor will tell you if it might be an option for you.

If you have chemoradiotherapy, you don't need to have surgery to remove your bladder. This is sometimes called bladder sparing treatment. 

You might have a course of chemotherapy on its own before chemoradiotherapy. This is called neoadjuvant Open a glossary item chemotherapy.

How you have chemoradiotherapy

Chemotherapy

You usually have the chemotherapy during the 1st and 4th week of radiotherapy. You have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more.

There are different chemotherapy drugs, and different ways of having these drugs. Most often, for chemoradiotherapy you have a combination of 2 drugs:

  • fluorouracil (5FU)
  • mitomycin C

Or you might have other chemotherapy drugs, such as gemcitabine.

How you have it:

Week 1: You usually have an injection of mitomycin C into your vein on the first day of radiotherapy. You also have a drip (infusion) of fluorouracil into your bloodstream for 5 days. Fluorouracil is to be started at least 2 hours before the first radiotherapy treatment.

Week 4: At the beginning of the 4th week you have the fluorouracil as a drip for 5 days.

You usually have your chemotherapy through a PICC line so you can go home with it. PICC stands for peripherally inserted central catheter. PICC lines are long, plastic tubes that give the drugs directly into a large vein in your chest Open a glossary item. You have the tube put in just before your treatment starts and it stays there as long as you need it.

 

Diagram showing a PICC line

Radiotherapy

Before you begin treatment, the radiotherapy team works out:

  • how much radiation you need to treat your cancer
  • how to deliver the treatment as safely as possible

They divide the dose of radiotherapy into a number of smaller treatments. They call each treatment a fraction. This is called radiotherapy planning.

You have radiotherapy treatment in the hospital radiotherapy department. Usually, treatments are once a day from Monday to Friday with a rest at the weekend. For invasive bladder cancer this will last between 4 and 7 weeks.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Everyone is different and the side effects Open a glossary item vary from person to person. This treatment may cause more severe side effects than having radiotherapy or chemotherapy on its own. 

Generally radiotherapy can cause:

  • tiredness and weakness

  • reddening or darkening of your skin

  • passing urine more often

  • inflammation of your bowel causing diarrhoea

  • sickness

Chemotherapy side effects depend on what drug you have, how much you have and how you react to it. Side effects often include:

  • feeling or being sick

  • loss of appetite

  • weight loss

  • feeling very tired and weak

  • a lower resistance to infection

  • bleeding and bruising easily

  • diarrhoea or constipation

  • hair loss (which usually comes back after you have finished treatment)

Chemotherapy before chemoradiotherapy

You might have chemotherapy before starting your course of chemoradiotherapy. This is called neoadjuvant chemotherapy. You usually have different chemotherapy drugs.

  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2015

  • Radiotherapy in practice: External Beam Therapy (3rd edition)
    P Hoskin
    Oxford University Press, 2019

  • Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
    T Powles and others
    ESMO Annals of Oncology, 2022. Volume 33, Issue 3, Pages 244-258

  • Radiotherapy dose fractionation (3rd Edition)
    The Royal College of Radiologists, 2019

Last reviewed: 
22 Aug 2025
Next review due: 
22 Aug 2028

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