How to cite: Hamstra DA. Bladder sparing tri-modality therapy updates 2025. Grand Rounds in Urology. Published September 19, 2025. Accessed December 2025. https://grandroundsinurology.com/bladder-sparing-tri-modality-therapy-updates-2025/
Summary
Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, Chief of Radiation Oncology, Baylor College of Medicine, Houston, Texas, provides an evidence-based update on bladder-sparing tri-modality therapy (TMT) for muscle-invasive bladder cancer. He shares that TMT combines transurethral resection of bladder tumor (TURBT), chemotherapy, and radiation. Dr. Hamstra notes that the North American approach traditionally limits inclusion to patients without carcinoma in situ, hydronephrosis, or poor bladder function. In contrast, the United Kingdom model treats a broader patient population, emphasizing continuous chemoradiation for both curative and palliative contexts.
Dr. Hamstra highlights long-term results from the BC2001 trial showing that adding 5-FU and mitomycin C to radiation improves local-regional control and bladder cancer–specific survival without increasing urinary or rectal toxicity. Matched institutional analyses comparing cystectomy and TMT demonstrate no significant differences in overall, metastasis-free, or cancer-specific survival, supporting TMT as a valid alternative even for surgical candidates.
He reviews retrospective data suggesting that neoadjuvant chemotherapy may further improve survival in TMT. The upcoming SWOG 1806 study evaluates chemoradiation plus atezolizumab versus chemoradiation alone, with bladder-intact event-free survival as the primary endpoint. He also discusses the newly opened SWOG S2427 (BRIGHT) trial, testing pembrolizumab with radiation after neoadjuvant therapy in patients achieving downstaging to ≤ T1.
Dr. Hamstra argues that TMT remains underutilized but viable for appropriately selected patients with muscle-invasive disease, including those with nodal involvement. Ongoing studies will define the optimal role of checkpoint inhibitors and confirm whether immunoradiotherapy can further improve long-term outcomes.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient.
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ABOUT THE AUTHOR
Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, serves as a Professor and the Chairman of Radiation Oncology at Baylor College of Medicine, for the Dan L. Duncan Comprehensive Cancer Center in Houston, Texas. Dr. Hamstra’s research has focused on advanced radiation and MRI in the treatment of CNS and prostate cancers, focusing on patient-reported quality of life.
