Chemoradiotherapy as a bladder-preservation approach for muscle-invasive bladder cancer: current status and perspectives

Abstract

Radical cystectomy has been considered the gold standard for the treatment of muscle-invasive bladder cancer. However, because of disappointing results with radical surgery in terms of survival and decreased quality of life (QOL), bladder-preservation treatment has been introduced as an alternative to radical cystectomy. The primary purpose of the bladder-preservation approach has been to maximize overall cure rates, with the secondary purpose being to preserve the patient's bladder. The modalities used to ensure successful bladder preservation include radical transurethral resection (TUR), concurrent cisplatin (CDDP)-based chemotherapy, and radiotherapy. In patients who achieve a complete response (CR) after trimodality therapy, 5-year survival rates of more than 50%, the same as those of radical cystectomy, can be achieved and 70% of this group will retain an intact functional bladder. In this article, bladder-preservation studies using chemoradiotherapy are reviewed.

The negative-balance isolated pelvic perfusion method using ultrahigh-dose cisplatin for invasive bladder cancer with poor risk

“…It was reported that complete response (CR) to invasive bladder cancer was observed in 76-91% of cases, and the overall 5-year survival rate was 66-74% after induction of multimodality bladder preservation therapy using intraarterial chemotherapy [2,7,8]. These results are similar to those achieved by radical cystectomy.…”

“…However, there are some patients who do not choose radical cystectomy, although the neobladder would improve their quality of life (QOL). Several protocols for bladder preservation in cases of invasive bladder cancer have been reported [1][2][3]. Recently, multimodality bladder preservation therapy for invasive bladder cancer was found to have similar treatment efficacy to radical cystectomy.…”

Selective bladder preservation with curative intent for muscle‐invasive bladder cancer: A contemporary review

“…[4][5][6][7] Briefly, several groups, including Harvard University in the USA, the University of Paris in France and the University of Erlangen in Germany, reported that the combination of TURBT, chemotherapy and radiotherapy yielded more favorable outcomes than those provided by monotherapies or other combinations of a subset of the three modalities. [8][9][10] Over the past two decades, trimodality therapy has been investigated in several prospective studies carried out mainly by the RTOG; 5-year OS rates ranged from 50% to 60%, which were comparable to those of RC series, 11,12 and 40-45% of the patients maintained their native bladder.…”

Respuesta y supervivencia libre de progresión en tumores vesicales en estadios T2-T4 tratados con tratamiento trimodal de conservación vesical

“…Aunque las pautas de preservació n vesical se desarrollaron inicialmente como una alternativa paliativa para pacientes que o bien no eran candidatos a recibir tratamiento quirú rgico mediante cistectomía radical o bien rechazaban este tratamiento, la experiencia acumulada ha ido puliendo las pautas y la selecció n de pacientes, y hoy, con alrededor de 1.000 casos documentados tratados con conservació n, podemos decir que en pacientes seleccionados se puede conservar la vejiga sin comprometer los niveles de supervivencia 7 . En todos los protocolos de conservació n, el tratamiento se divide en una fase de inducció n con quimioterapia-radioterapia con o sin quimioterapia neoadyuvante, una inmediata valoració n de la respuesta y un tratamiento de consolidació n con quimioterapia-radioterapia con o sin quimioterapia adyuvante.…”