INVASIVE BLADDER-CANCER - TREATMENT STRATEGIES USING TRANSURETHRAL SURGERY, CHEMOTHERAPY AND RADIATION-THERAPY WITH SELECTION FOR BLADDER CONSERVATION

Purpose: Combined modality therapy has become the standard oncologic a pproach to achieve organ preservation in many malignancies, Methods an d Materials: Although radical cystectomy has been considered as standa rd treatment for invasive bladder carcinoma in the United States, good results have been recently reported from several centers using multim odality treatment, particularly in patients with clinical T2 and T3a d isease who do not have a ureter obstructed by tumor, Results: The comp onents of the combined treatment are usually transurethral resection o f the bladder tumor (TURBT) followed by concurrent chemotherapy and ra diation therapy, Following an induction course of therapy a histologic response is evaluated by cystoscopy and rebiopsy, Clinical ''complete responders'' (tumor site rebiopsy negative and urine cytology with no tumor cells present) continue with a consolidation course of concurre nt chemotherapy and radiation, Those patients not achieving a clinical complete response are recommended to have an immediate cystectomy, In dividually the local monotherapies of radiation, TURBT, or multidrug c hemotherapy each achieve a local control rate of the primary tumor of from 20 to 40%, When these are combined, clinical complete response ra tes of from 65 to 80% can be achieved, Seventy-five to 85% of the clin ical complete responders will remain with bladders free of recurrence of an invasive tumor, Conclusions: Bladder conservation trials using c ombined modality treatment approaches with selection for organ conserv ation by response of the tumor to initial treatment report overall 5-y ear survival rates of approximately 50%, and a 40-45% 5-year survival rate with the bladder intact, These modern multimodality bladder conse rvation approaches offer survival rates similar to radical cystectomy for patients of similar clinical stage and age, Bladder-conserving the rapy should be offered to patients with invasive bladder carcinoma as a realistic alternative to radical cystectomy by experienced multimoda lity teams of urologic oncologists. (C) 1997 Elsevier Science Inc.