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Bladder preservation: optimizing radiotherapy and integrated treatment strategies
Raymond H Mak1, Anthony L Zietman, Niall M Heney
1Department of Radiation, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
BJU International
|November 28, 2008
Summary
Bladder preservation therapy combining surgery, radiation, and chemotherapy offers selected muscle-invasive bladder cancer patients a chance for long-term survival with an intact bladder, comparable to radical cystectomy outcomes.
Area of Science:
- Urology
- Oncology
- Radiation Oncology
Background:
- Radical cystectomy (RC) is the standard for muscle-invasive bladder cancer.
- Bladder preservation strategies have evolved over 20 years.
- Combined modality therapy offers an alternative for selected patients.
Purpose of the Study:
- To evaluate the efficacy of bladder preservation therapy for muscle-invasive bladder cancer.
- To compare bladder preservation outcomes with radical cystectomy.
- To highlight key components of successful bladder preservation protocols.
Main Methods:
- Patient selection based on clinical staging.
- Combined therapy: maximal transurethral resection, radiation, and chemotherapy.
- Cystoscopic assessment, surveillance, and salvage cystectomy for non-responders or recurrence.
Main Results:
- Complete response rates of 60-85% achieved.
- 5-year survival rates range from 50-60%.
- Intact bladder survival rates are 40-45%.
Conclusions:
- Bladder preservation is a safe and effective alternative to RC for selected patients.
- Survival rates are comparable to contemporary radical cystectomy series.
- Further refinement of bladder preservation approaches is ongoing to improve outcomes.
