Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).

技术进步促进了膀胱癌患者的特定放射治疗。图像引导放射治疗 (IGRT) 的发展使这成为可能。特别具有变革性的是将体积成像集成到工作流程中。使用锥形束计算机断层扫描和磁共振成像可视化膀胱目标的能力最初有助于确定分次间和分次内目标变化的幅度。它使人们更有信心确定每个部分的真实解剖结构。输送到膀胱的剂量的增加的确定性允许安全地减少计划目标体积裕度。因此，IGRT 改善了目标覆盖范围，减少了对周围组织的整体剂量。根据当天的解剖结构，使用 IGRT 反馈到计划和剂量输送优化已启用自适应放疗膀胱解决方案。在这里，我们回顾了支持 IGRT 和自适应放射治疗策略的逐步发展，用于外部束膀胱癌放射治疗。我们根据放射肿瘤学技术创新的系统临床评估框架 (R-IDEAL) 提供证据。