[Bladder-sparing trimodal therapy for muscle invasive bladder cancer]

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Muscle invasive bladder cancer (MIBC) management traditionally involves radical cystectomy, associated with significant morbidity and impact on quality of life.
• Organ-sparing strategies aim to balance tumor control with functional preservation, particularly relevant for bladder cancer.
• Bladder preservation through trimodal therapy (TMT) is an emerging alternative to cystectomy for select MIBC patients.

Purpose of the Study:

• To review the modalities, advantages, and limitations of trimodal therapy (TMT) for muscle invasive bladder cancer (MIBC).
• To compare TMT with radical cystectomy regarding oncological outcomes, quality of life, and patient selection criteria.
• To explore predictive factors, including molecular biomarkers, for optimizing TMT eligibility.

Main Methods:

• Review of existing literature on trimodal therapy (maximal trans-urethral resection, chemoradiotherapy) for MIBC.
• Comparative analysis of oncological results and quality of life data between TMT and cystectomy.
• Critical evaluation of predictive factors for response to chemoradiotherapy.

Main Results:

• TMT and cystectomy demonstrate comparable oncological outcomes in appropriately selected MIBC patients.
• Salvage cystectomy rates are around 15% at 5 years, with no increased morbidity compared to upfront cystectomy.
• Quality of life data favors bladder-sparing approaches, highlighting the importance of functional preservation.

Conclusions:

• Trimodal therapy is a viable bladder-sparing option for select MIBC patients, offering similar oncological control to cystectomy.
• Patient selection based on predictive factors and molecular biomarkers is crucial for optimizing TMT success.
• Multidisciplinary collaboration and shared decision-making are essential for effective MIBC management.