[Combination chemotherapy and radiotherapy in the conservative treatment of infiltrating bladder carcinoma].
OBJECTIVE
To review the state-of-the-art of treatment of infiltrating cancer of the urinary bladder with combination neoadjuvant or concomitant chemotherapy and full dose radiotherapy for organ preservation.


METHODS
Series from different hospitals, cooperative study groups and the experience of the Catalan Institute of Oncology in conservative treatment of bladder cancer with combined radio and neoadjuvant or concomitant chemotherapy are analyzed.


RESULTS
Stage, presence of hydronephrosis, associated carcinoma in situ and response to treatment are some of the decisive prognostic factors. Wide transurethral resection was also found to be of prognostic importance. Cisplatin is currently the most effective cytostatic agent. Patient selection improves the mortality rate and percentage of patients that are disease free and with a functioning bladder, especially when concomitant chemo and radiotherapy are utilized. Late bladder toxicity does not increase and the utilization of some cytostatic regimens is limited by acute toxicity.


CONCLUSIONS
Patient selection for conservative treatment aimed at bladder preservation increases the percentage of bladders preserved. The possibility of extending the indications for this therapeutic approach should be investigated in controlled trials.
Villà Freixa
S
S
Servicio de Oncología Radioterápica, Institut Català d'Oncologia, Hospitalet, Barcelona, España. svilla@ico.scs.es
D003131:Combined Modality Therapy; D006801:Humans; D011379:Prognosis; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*