Bladder Sparing Approaches for Muscle-Invasive Bladder Cancers

Area of Science:

• Uro-oncology
• Surgical oncology
• Radiation oncology

Background:

• Organ preservation is increasingly used for muscle-invasive bladder cancer.
• Maximal transurethral resection of bladder tumor (TURBT) with chemoradiation is a favored bladder preservation approach.
• Phase III trials demonstrate chemoradiotherapy's superiority over radiotherapy alone.

Purpose of the Study:

• To review bladder preservation strategies in muscle-invasive bladder cancer.
• To compare bladder preservation with radical cystectomy.
• To highlight the importance of patient selection and multidisciplinary care.

Main Methods:

• Review of Phase III trials comparing chemoradiotherapy and radiotherapy.
• Discussion of bladder preservation techniques versus radical cystectomy.
• Emphasis on patient selection criteria and lifelong surveillance.

Main Results:

• Concurrent chemoradiotherapy yields local control comparable to radical surgery.
• Bladder preservation offers potential quality of life benefits.
• Lifelong bladder surveillance is essential for detecting recurrence.

Conclusions:

• Bladder preservation is a viable option for select patients unfit for or declining cystectomy.
• Radical cystectomy and chemoradiation should be viewed as complementary, not competing, treatments.
• Multidisciplinary team management and meticulous patient selection are vital for optimizing outcomes in bladder preservation therapy.