OPPORTUNITIES WITH COMBINED-MODALITY THERAPY FOR SELECTIVE ORGAN PRESERVATION IN MUSCLE-INVASIVE BLADDER-CANCER

Combined-modality therapy for organ preservation represents an appropr iate alternative to radical surgery in the management of several malig nant diseases. The standard therapy for muscle-invasive bladder cancer in the United States has been radical cystectomy. Although the sequel ae of radical surgery have been ameliorated somewhat by techniques for the construction of orthotopic bladders, the ideal therapy should bot h cure the patient of cancer and maintain a functioning natural bladde r. Years of experience in Europe and Canada with bladder preservation using radiation therapy are documented. Advances in transurethral surg ery technique and in the combination of radiation and chemotherapy hav e led to safe and effective regimens for patients with bladder cancer. Several recent trials with combined-modality therapy have established this treatment as a viable alternative to radical cystectomy in selec ted patients. (C) 1996 Wiley-Liss, Inc.