Bladder preservation therapy for muscle invasive bladder cancer: the past, present and future

Abstract

Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer, but some patients have medically inoperable disease or refuse cystectomy to preserve their bladder function. Bladder preservation therapy with transurethral resection of the bladder tumor and concurrent chemoradiotherapy, known as trimodal treatment, is regarded to be a curative-intent alternative to radical cystectomy for patients with muscle invasive bladder cancer during the past decade. After the development of immune checkpoint inhibitors, a world-changing breakthrough occurred in the field of metastatic urothelial carcinoma and many clinical trials have been conducted against non-muscle invasive bladder cancer. Interestingly, preclinical and clinical studies against other malignancies have shown that immune checkpoint inhibitors interact with the radiation-induced immune reaction. As half of the patients with muscle invasive bladder cancer are elderly, and some have renal dysfunction, not only as comorbidity but also because of hydronephrosis caused by their tumors, immune checkpoint inhibitors are expected to become part of a new therapeutic approach for combination treatment with radiotherapy. Accordingly, clinical trials testing immune checkpoint inhibitors have been initiated to preserve bladder for muscle invasive bladder cancer patients using radiation and immune checkpoint inhibitors with/without chemotherapy. The objective of this review is to summarize the evidence of trimodal therapy for muscle invasive bladder cancer during the past decade and to discuss the future directions of bladder preservation therapy in immuno-oncology era.

Three-Dimensional Ultrasound Images in the Assessment of Bladder Tumor Health Monitoring under Deep Learning Algorithms

“…In recent years, deep learning algorithms have continued to advance and develop, and have been transformed and upgraded on the basis of the original algorithms. The CNN, a representative product of its development, has reportedly reduced the feature recognition error rate to 3.5%, and it can be said to be a very promising algorithm [ 21 , 22 ].…”

Effect of Radical Laparoscopic Surgery and Conventional Open Surgery on Surgical Outcomes, Complications, and Prognosis in Elderly Patients with Bladder Cancer

“…Open radical cystectomy is the standard method for treating patients with bladder cancer, and its therapeutic effects are universally recognized, but the surgical procedure is significantly traumatic for the patient and not only the amount of bleeding but also the postoperative complications adversely affect the patient's recovery [ 13 ]. Therefore, patients need a longer period of time to recover after the completion of the surgery, coupled with the degeneration of physiological organ functions, decreased immunity, and more underlying diseases in elderly patients, who have relatively low tolerance for open surgery [ 14 ]. Therefore, not only the surgical risk is high but also the postoperative complication rate is higher.…”

MIR100HG Regulates CALD1 Gene Expression by Targeting miR-142-5p to Affect the Progression of Bladder Cancer Cells in vitro, as Revealed by Transcriptome Sequencing

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