Radiation therapy

Radiation therapy plays an important role in the management of genitourinary cancers. Radiation can be used alone in the curative treatment of low- and favorable intermediate-risk prostate cancers; in combination with systemic therapy for the curative treatment of unfavorable intermediate- and high-risk prostate and selected bladder cancers; and as an organ-sparing alternative to up-front surgery for selected penile cancers. Precise, short-course, high-dose per fraction stereotactic body radiotherapy (SBRT) sees an increasing use for medically inoperable renal cell carcinoma (RCC) patients, selected prostate cancers, as well as for the ablation of prostate and RCC oligometastases. Radiation is also used as an adjuvant or salvage treatment after surgery for certain prostate and bladder cancer patients. Major technologic advances in the delivery of radiation, such as photon intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), SBRT, proton therapy, and novel setup devices, have markedly reduced acute and late toxicities, and in some cases, allowed for the delivery of higher doses with improved disease control. These advances have also led to the development of hypofractionated (higher-dose per fraction), shorter treatment courses, which are more convenient for patients and are now the standard of care for most prostate cancers. With these tools, urologists, medical oncologists, and radiation oncologists work together in close concert to develop the optimal multidisciplinary management plans for their patients.