Bladder preservation in muscle-invasive bladder cancer by conservative surgery and radiochemotherapy

Organ preservation has been investigated in muscle-invasive bladder cancer over the past decades as an alternative to standard radical cystectomy. The results of large prospective protocols and population-based studies sugges t that an organ-preserving approach is possible without deferring the survi val probability. Organ preservation requires a trimodal schedule, including transurethral surgery (transurethral resection of bladder tumor (TURBT)), radiation, and chemotherapy. A complete TURBT is the most important single prognostic factor, and should be attempted. Radiotherapy, in conjunction wi th concurrent platinum-based chemotherapy, can control the vast majority of urothelial bladder tumors. The histologically-proven complete remission ra tes of macroscopic tumors (unresectable by TURBT) lie in the range of about 70%. After radiochemotherapy, a histological response evaluation with repe ated TURBT is recommended. Patients with residual tumor require salvage cys tectomy. In cases of complete remission, patients can maintain their bladde rs but they should be closely followed over years. The risk of severe late- radiation sequelae is low, in the range of less than 5%. About 75% of long- term survivors maintain a normally functioning bladder. (C) 2001 Wiley-Liss , Inc.