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Urology: Muscle-invasive bladder bladder-preservation chemoRT

Free question published 23 August 2026

UrologyMuscle-invasive bladder bladder-preservation chemoRT

A 70-year-old man with muscle-invasive urothelial bladder cancer (cT2 N0 M0) wishes to preserve his bladder and chooses radical radiotherapy after discussion with the urologist, clinical oncologist and clinical nurse specialist. His renal function and performance status are good. To optimise locoregional control, which concurrent radiosensitising regimen is best supported for use with his radiotherapy?

  1. AConcurrent mitomycin C and fluorouracil (5-FU)
  2. BConcurrent gemcitabine and carboplatin
  3. CRadiotherapy alone without a radiosensitiser
  4. DConcurrent capecitabine alone
  5. EConcurrent weekly cisplatin alone

Why A is correct

NICE NG2 (1.5.15) recommends using a radiosensitiser such as mitomycin in combination with fluorouracil, or carbogen with nicotinamide, when giving radical radiotherapy for muscle-invasive bladder cancer. The BC2001 trial showed that synchronous mitomycin C and fluorouracil with radiotherapy significantly improved locoregional control compared with radiotherapy alone.

And why the others are not

  • BIncorrect: gemcitabine and carboplatin is a systemic regimen, not the recommended concurrent radiosensitiser in NG2.
  • CIncorrect: radiotherapy alone gives inferior locoregional control; BC2001 supports adding a radiosensitiser.
  • DIncorrect: capecitabine monotherapy is not the evidence-based bladder radiosensitiser.
  • EIncorrect: single-agent concurrent cisplatin is not the NICE-specified bladder radiosensitiser regimen.

Source NICE NG2 — Bladder cancer: diagnosis and management — National Institute for Health and Care Excellence. Bladder cancer: diagnosis and management. NICE guideline NG2. Published 25/02/2015.

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