The current status of bladder preservation in the treatment of muscle invasive bladder cancer

Citation
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
Citations number
53
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
JOURNAL OF UROLOGY
ISSN journal
0022-5347 → ACNP
Volume
164
Issue
3
Year of publication
2000
Part
1
Pages
627 - 632
Database
ISI
SICI code
0022-5347(200009)164:3<627:TCSOBP>2.0.ZU;2-5
Abstract
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.