Multimodality bladder preservation therapy for muscle-invasive bladder tumors

The standard treatment for muscle-invasive bladder cancer in the United States is still radical cystectomy with pelvic lymph node dissection. An alternative to cystectomy is multimodality bladder preservation with thorough transurethral resection, chemotherapy, and radiation therapy. This report addresses several key issues to be considered when selecting patients for a multimodality treatment for invasive bladder cancer. Recent protocols incorporating various fractionation schemes for radiation and alternative chemotherapeutic agents are reviewed. Quality of life associated with bladder preservation after a multimodality approach is also discussed.