Bladder-sparing strategies in patients with clinically localized muscle-invasive bladder cancer

Abstract

Purpose of review Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer (MIBC). In this context, bladder-sparing strategies (BSS) have been investigated as viable alternatives for patients who are unfit for radical cystectomy or aim to preserve their bladder without compromising oncological outcomes. This review aims to provide the most up-to-date evidence on BSSs as an alternative treatment for patients with MIBC. Recent findings Different studies have highlighted the long-term efficacy of trimodal therapy or chemoradiation protocols. However, due to the lack of randomized controlled trials, there is still a lack of high-level evidence on BSS efficacy as compared to radical cystectomy. Consequently, the adoption of these approaches is still limited. A possible turning point could be represented by the introduction of immunotherapy, as several studies are investigating the potential combination with chemoradiotherapy or radiotherapy alone. Patient selection, together with the implementation of new predictive biomarkers and imaging tools, may improve the efficacy of BSS in the near future. Summary Radical cystectomy with perioperative chemotherapy remains the gold standard treatment for MIBC patients. Nevertheless, BSS can be considered a viable option in selected patients who desire to preserve their bladder. Further evidence is needed to clearly state the role of BSS in MIBC.

Non-Surgical Bladder-Sparing Multimodal Management in Organ-Confined Urothelial Carcinoma of the Urinary Bladder: A Population-Based Analysis

“…Recently, bladder-sparing strategies such as trimodal therapy have become more popular as they can achieve favorable cancer control outcomes with the preservation of organ function and quality of life [9,22]. However, scarce information exists about the use of CT or RT in isolation after TURBT, instead of CT and RT combination.…”

“…For all the above reasons, non-surgical bladder-sparing strategies are gaining popularity for patients with organ-confined urothelial carcinoma of the urinary bladder [9]. Different strategies have been investigated over the years.…”

“…Subsequently, several trials demonstrated the added value of chemotherapy administration in patients treated with TURBT + RT in terms of cancer-specific survival [13]. Since then, the combination of TURBT, RT, and CT, namely trimodal therapy, represented the most recognized and validated organ-sparing strategy for patients with organ-confined urothelial carcinoma of the urinary bladder [9,[12][13][14][15]. The rationale of this multimodal treatment is to achieve optimal local control through the maximal resection of the bladder tumor plus the irradiation of the resection bed with or without the adjacent lymph nodes.…”

“…The rationale of this multimodal treatment is to achieve optimal local control through the maximal resection of the bladder tumor plus the irradiation of the resection bed with or without the adjacent lymph nodes. Additionally, the inclusion of systemic chemotherapy serves a dual purpose: treating eventual micro-metastatic sites and acting as a radiosensitizer [1,9,12,13]. Despite neoadjuvant chemotherapy prior to radical cystectomy showing better cancer-control outcomes, the role and setting of systemic chemotherapy in the context of TMT are still under debate.…”