Can bladder preservation therapy come to the center stage?

Abstract

Decision-making in urological cancer care requires a multidisciplinary approach for refinement, but its impact on urothelial carcinoma of the bladder has not been fully addressed for the past three decades, except for the latest immunological checkpoint inhibitor approved by the U.S. Food and Drug Administration for metastatic muscle-invasive bladder cancer that is resistant to platinum-based chemotherapy. For the time being, radical cystectomy is the gold standard of curative therapy for muscleinvasive bladder cancer. Trimodal therapy that combines chemotherapy for the purpose of radiation sensitization, external beam radiotherapy and transurethral resection of bladder tumor has emerged as a potential alternative treatment option that preserves the bladder. In lack of randomized studies for bladder preservation therapy compared with surgery, the principles of management of urothelial carcinoma of the bladder have evolved in recent times, with an emphasis on bladder preservation. A number of bladder preservation techniques are available to the surgeon; however, appropriately selected patients with muscle-invasive bladder cancer should be offered the opportunity to discuss various treatment options, including organ-sparing trimodal therapy. The aim of the present study was to compare the primary outcomes of the available treatment methods and identify the sources of variance among studies. A review of various bladder preservation techniques in vogue for the management of urothelial carcinoma of the bladder is discussed.

Renal function after bladder‐preserving therapy for patients with muscle‐invasive bladder cancer: Results of selective bladder‐preserving tetramodality therapy consisting of maximal transurethral resection, induction chemoradiotherapy and partial cystectomy

“…To improve patients' quality of life without compromising their oncological outcomes, trimodal therapy (TMT) consisting of transurethral resection of the bladder tumor, chemotherapy and radiation therapy has emerged as a potential alternative treatment option that preserves the bladder. 1 The incidence of renal deterioration was comparatively high after RC. Urinary tract obstruction induced by ureteroenteric stricture was the leading cause of rapid renal function decline after surgery, whereas hypertension, diabetes mellitus and acute pyelonephritis were associated with the development of late renal function deterioration.…”

Relationship of frailty with treatment modality selection in patients with muscle-invasive bladder cancer (FRART-BC study)

“…Relationship of frailty with treatment modality selection in patients with muscle-invasive bladder cancer (FRART-BC study) demonstrated comparable survival outcomes when patients were appropriately selected (7)(8)(9)(10)(11)(12)(13). However, no level 1 evidence supported the definitive selection criteria for TMT.…”

Carbon ion radiotherapy for bladder cancer: A case report

“…Radical cystectomy is considered the treatment of choice for muscle-invasive bladder carcinoma[ 1 - 6 ]. Surgery may not be possible, however, for patients with locally advanced tumors or for those considered medically unfit[ 7 , 8 ].…”