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Published findings synthesized in this narrative review indicate that maximal TURBT followed by concurrent chemoradiotherapy can reach complete response rates near 80%, with 5-year overall survival comparable to cystectomy in selected patients. The review also summarizes emerging directions including whole-pelvis strategies, hypofractionated approaches, immunotherapy combinations, and biomarker-driven selection, emphasizing the need for prospective randomized trials to optimize target volumes, fractionation, and integration with systemic agents.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/radiotherapy-for-high-risk-non-muscle-invasive-bladder-cancer-current-evidence-and-future-directions/354064/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/radiotherapy-for-high-risk-non-muscle-invasive-bladder-cancer-current-evidence-and-future-directions/354064.png","ImageObject",300,407,{"name":92,"@type":93},"Fahsai","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is the role of radiotherapy in high-risk NMIBC considered controversial?","Question",{"text":113,"@type":114},"Historically, evidence has been limited and heterogeneous, leaving radiotherapy’s place in guidelines undefined despite growing exploration.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatment approach does the review suggest may improve outcomes in high-risk NMIBC?",{"text":118,"@type":114},"Maximal transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy is associated with improved complete response rates and survival outcomes in selected patients.",{"name":120,"@type":111,"acceptedAnswer":121},"What future research directions does the review highlight?",{"text":122,"@type":114},"Ongoing work includes whole-pelvis radiotherapy comparisons, hypofractionated regimens, immunotherapy combinations, and biomarker-driven patient selection, with prospective randomized studies needed to define optimal parameters.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},354064,1790207532,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":105,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},549768702563,"https://ap-avatar.wpscdn.com/avatar/8000c4aa63b76e948b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786536092046926083","Review  \nRadiotherapy for High-Risk Non-Muscle-Invasive Bladder Cancer: Current Evidence and Future Directions  \nLucas Resende Salgado 1, Osama Zaytoun 1,*, Ahmed Rabie 2, *, Nicholas Murphy 1, Anthony Nehlsen 1, Kristin Hsieh 1, Zachary Dovey 1, Anum Aamir 1 and Kunal K. Sindhu 1  \nReceived: 24 February 2026  \nRevised: 9 April 2026  \nAccepted: 10 April 2026  \nPublished: 17 April 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Urology and Radiology, Mount Sinai, New York, NY 10029, USA; [lucas.resendesalgado@mountsinai.org](lucas.resendesalgado@mountsinai.org) (L.R.S.); [nicholas.murphy@mountsinai.org](nicholas.murphy@mountsinai.org) (N.M.); [anthony.nehlsen@mountsinai.org](anthony.nehlsen@mountsinai.org) (A.N.); [kristin.hsieh@mountsinai.org](kristin.hsieh@mountsinai.org) (K.H.); [zachary.dovey@mountsinai.org](zachary.dovey@mountsinai.org) (Z.D.); [anum.aamir@mountsinai.org](anum.aamir@mountsinai.org) (A.A.); [kunal.sindhu@mountsinai.org](kunal.sindhu@mountsinai.org) (K.K.S.)  \n2 Department of Urology, Northwell Health, New York, NY 11042, USA  \n* Correspondence: [osama.zaytoun@mountsinai.org](osama.zaytoun@mountsinai.org) (O.Z.); [dr.ahmed.hamdy.amin@gmail.com](dr.ahmed.hamdy.amin@gmail.com) (A.R.); Tel.: +1-3477849723 (O.Z.)  \nSimple Summary  \nRadiotherapy for high-risk non-muscle-invasive bladder cancer (NMIBC) has historically been supported by limited, heterogeneous data, leaving its role undefined in guidelines. Existing evidence—largely retrospective series and one phase II trial—suggests that maximal transurethral resection followed by concurrent chemoradiotherapy can achieve complete response rates of approximately 80% and 5-year overall survival comparable to cystectomy in selected patients. Our review synthesizes these data and highlights two key findings: first, whole-pelvis radiotherapy may offer a survival advantage over bladder-only treatment, based on a recent meta-analysis in muscle-invasive bladder cancer; second, emerging trials are now testing hypofractionated radiotherapy, immunotherapy combinations, and biomarker-driven selection specifically in NMIBC. These findings underscore the need for prospective, randomized studies to define optimal target volumes, fractionation, and integration with novel systemic agents, ultimately moving radiotherapy from an investigational salvage option toward an established bladder-preserving standard for well-selected patients.  \nAbstract  \nIntroduction: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 78% of newly diagnosed bladder cancers and is characterized by high recurrence ratesand variable progression risk. While transurethral resection of bladder tumor (TURBT) followed by intravesical therapy remains standard management, optimal treatment of high-risk and Bacillus Calmette-Guerin (BCG)-unresponsive disease remains controversial. Radiotherapy (RT), particularly in combination with chemotherapy, has been explored as a bladder-preserving alternative. Material and Methods: We conducted a narrative review of published literature evaluating the role of definitive RT in high-risk NMIBC, with emphasis on T1 disease. Retrospective series, prospective trials, meta-analyses, and contemporary guideline recommendations were examined. For each included study, we extracted data on the extent of TURBT (maximal vs. incomplete/non-specified), use and type of concurrent chemotherapy, radiotherapy technique (3D-conformal, IMRT, or proton), treatment volume (bladder only vs. whole pelvis), and dose/fractionation schedule. Results: Early studies evaluating RT alone demonstrated modest complete response rates. More recent approaches incorporating maximal TURBT followed by concurrent chemoradiotherapy report improved outcomes, with complete response rates of approximately 80–88% and  \n5-year ","cbCaileBlmGCF01Z","https://ap.wps.com/l/cbCaileBlmGCF01Z","pdf",255139,"English","# Simple Summary\n# Abstract\n# Keywords\n# 1. Introduction\n## Burden and epidemiology of bladder cancer\n## Non-muscle-invasive bladder cancer risk profile\n## Management of high-risk NMIBC and BCG-unresponsive disease","[{\"question\":\"Why is the role of radiotherapy in high-risk NMIBC considered controversial?\",\"answer\":\"Historically, evidence has been limited and heterogeneous, leaving radiotherapy’s place in guidelines undefined despite growing exploration.\"},{\"question\":\"What treatment approach does the review suggest may improve outcomes in high-risk NMIBC?\",\"answer\":\"Maximal transurethral resection of the bladder tumor followed by concurrent chemoradiotherapy is associated with improved complete response rates and survival outcomes in selected patients.\"},{\"question\":\"What future research directions does the review highlight?\",\"answer\":\"Ongoing work includes whole-pelvis radiotherapy comparisons, hypofractionated regimens, immunotherapy combinations, and biomarker-driven patient selection, with prospective randomized studies needed to define optimal parameters.\"}]","Radiotherapy for High-Risk Non-Muscle-Invasive Bladder Cancer: Current Evidence and Future Directions | PDF",1790108682,28]