Chemoradiotherapy for bladder cancer

What is chemotherapy and radiotherapy?

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.

The chemotherapy helps the radiotherapy to work better.

When do you have it?

Your doctor might suggest you have ​radiotherapy​ as your main treatment instead of ​surgery. 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​ 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​. You have the tube put in just before your treatment starts and it stays there as long as you need it.

Find out more about having 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.

Find out more about having radiotherapy for bladder cancer

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​ 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

Find out more about the side effects of radiotherapy

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)

Find out more about the side effects of chemotherapy

Chemotherapy before chemoradiotherapy

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

Find out about other treatment for invasive bladder cancer