Chemoradiotherapy for bladder cancer

Chemoradiotherapy means having chemotherapy and radiotherapy treatment together.

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 to kill cancer cells.

When do you have it?

You might have chemoradiotherapy instead of surgery. The chemotherapy drugs help the radiotherapy to work better. They are called radiosensitisers.

You might have a course of chemotherapy on its own before you start chemoradiotherapy. This is called neoadjuvant chemotherapy.

How you have chemoradiotherapy


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.

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. 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


Before you begin treatment, the radiotherapy team works out how much radiation you need. They divide it 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.


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 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
  • hair loss from your pubic area (this usually returns after you’ve finished treatment)

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. The aim of this neoadjuvant chemotherapy is to treat any cancer that might have spread outside the bladder.

Last reviewed: 
21 Jun 2019
  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2015

  • Neoadjuvant Chemotherapy for Patients with Muscle-invasive Urothelial Bladder Cancer Candidates for Curative Surgery: A Prospective Clinical Trial Based on Cisplatin Feasibility
    G Schinzari and others
    International Journal of Cancer Research and Treatment, 2017. Volume 37, Number 11, Pages 6453 – 5458

  • EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
    J A Witjes and others
    European Association of Urology, 2017

  • Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Systemic Review and Two-Step Meta – Analysis
    M Yin and others
    The Oncologist, 2016. Volume 21, Issue 6, Pages 708 – 715

  • Radiotherapy dose fractionation  (2nd Edition)
    The Royal College of Radiologists, 2016

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact with details of the particular issue you are interested in if you need additional references for this information.

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