Hl. Kim et Gd. Steinberg, The current status of bladder preservation in the treatment of muscle invasive bladder cancer, J UROL, 164(3), 2000, pp. 627-632
Purpose: Bladder preserving strategies for muscle invasive bladder cancer h
ave evolved from single modality to multimodality treatment approaches with
improved results.
Materials and Methods: We review the rationale for a multimodality approach
to treat invasive bladder cancer and the results of some recent multimodal
ity bladder sparing treatments. In addition, we compare this approach to ra
dical cystectomy.
Results: Multimodality bladder sparing treatment involves combined transure
thral bladder resection, external beam radiation with concurrent radiosensi
tizers and cisplatin based chemotherapy. With this approach overall 5-year
survival is 48% to 63% and overall 5-year survival with the bladder intact
is 36% to 43%. Survival with this approach is comparable to that in series
of patients treated with primary radical cystectomy. The primary impetus fo
r a multimodality bladder sparing approach is the improved quality of life
associated with retaining the native bladder. However, the multimodality bl
adder sparing approach involves a complex treatment schedule associated wit
h significant morbidity and mortality. Cystectomy is eventually required af
ter attempted bladder preservation in 34% to 45% of cases and the rate of s
uperficial recurrence is approximately 28%.
Conclusions: Multimodality bladder sparing treatment is a viable option at
centers with a dedicated multidisciplinary team. However, primary radical s
urgery remains the standard of care for invasive bladder cancer.