[Infiltrating cancer of the bladder. Is concomitant radiochemotherapy an alternative to cystectomy?]

Infiltrating bladder cancer is an extremely severe condition causing death within 5 years due to metastatic extension in one-half of the patients whatever the treatment. It is well known that radiotherapy is successful in treating some patients while partial exeresis (open surgery or laparoscopic surgery) is effective in others. Current chemotherapy protocols (usually well-tolerated) increase the efficacy of radiotherapy but it is surprising that over the last 10 years, total cystectomy has become the first line treatment proposed for patients with infiltrating bladder cancer. The operation is a major procedure leading to an important morbidity and mortality. Since 1988, we have decided not to rely on total cystectomy for such patients, but rather to use a treatment protocol associating endoscopic exercise of the tumour and radiochemotherapy. Our results allow confirmation that this protocol can provide curative treatment in certain cases without removing the entire bladder. We thus suggest that systematic amputation of the bladder for cancer is an obsolete procedure and raise the question as to the usefulness of total cystectomy in this disease?