Combined-Modality Treatment and Selective Organ Preservation in Invasive Bladder Cancer: Long-Term Results

Abstract

TUR with RCT is a reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage and unifocal tumors, in whom a complete TUR is accomplished.

Single nucleotide polymorphisms in DNA repair genes might be prognostic factors in muscle-invasive bladder cancer patients treated with chemoradiotherapy

“…The combined genotypes might therefore be valuable as an independent prognostic factor following CRT in muscleinvasive bladder cancer. Bladder-conserving therapy using combinations of chemotherapy, radiotherapy, and TUR has shown promising results (Dunst et al, 2001;Rödel et al, 2002), but not all tumours respond. The ability to predict tumour sensitivity to CRT would therefore be very helpful in patient selection for bladder conservation therapy (Sak et al, 2005).…”

“…Although the gold standard for the treatment of muscle-invasive urinary-bladder cancer is radical cystectomy followed by urinary diversion, this procedure is likely to impair the quality of life of the patient (Rödel et al, 2002). In many areas of cancer treatment, the trend in the 1990s was aimed at organ conservation using combined chemotherapy and radiation with or without conservative local surgery (Shipley et al, 2003).…”

“…In many areas of cancer treatment, the trend in the 1990s was aimed at organ conservation using combined chemotherapy and radiation with or without conservative local surgery (Shipley et al, 2003). In invasive bladder cancer, several groups have reported the value of combined-modality therapy, including transurethral resection (TUR), radiation therapy, and platinum-based systemic chemotherapy (Rödel et al, 2002;Shipley et al, 1998Shipley et al, , 2003. With these programs, cystectomy is reserved for patients with an incomplete response or local relapse after combined-modality treatment.…”

Concurrent Chemotherapy Improves the Overall Survival of Patients Irradiated for Locally Recurrent Bladder Cancer

“…Those unable to withstand radical surgery are referred for radiotherapy (7). In the case of primary organ-preserving treatment, radiotherapy was shown to be more effective with the addition of concurrent radiosensitizing chemotherapy (5,8,9). In the case of recurrent bladder cancer, patients are often older and less resilient than at the time of their primary treatment and may be unable to tolerate the addition of chemotherapy.…”

“…Therefore, bladder-preserving approaches including transurethral resection of bladder tumours (TURBT) followed by radiotherapy and chemotherapy have become more popular. After both radical cystectomy and bladder-preserving approaches, local recurrences are common, occurring in about 20% to 60% of patients (2,5). Pelvic lymph node metastases are also quite common (6).…”