The role of chemotherapy and radiation in organ-preservation strategies for muscle-invasive bladder cancer.
Radical cystectomy with pelvic lymph node dissection has been accepted as the standard treatment for muscle-invasive bladder cancer. Radiation therapy and chemotherapy are increasingly being implemented in bladder-preservation protocols to provide an alternative treatment to cystectomy. We review experience with radiation and chemotherapy in treating bladder cancer and their use in bladder-preservation protocols. Multimodality organ-sparing treatment strategies offer overall survival rates comparable to radical cystectomy and pelvic lymph node dissection in selected cases. However, bladder-preservation techniques risk local recurrence of potentially aggressive tumors whose long-term effect on cancer-specific survival has not been fully characterized. No improvement in quality of life has clearly been demonstrated with bladder-preservation regimens. Bladder-preservation protocols are costly and require precise coordination of multiple specialists as well as strict, life-long patient compliance. Bladder-preservation protocols should only be performed at tertiary care centers with experience in their administration and be limited to patients desiring an alternative cystectomy or who are not surgical candidates.
Bradley
Brian A
BA
University of Florida College of Medicine, Division of Urology, P.O. Box 100247, Gainesville, FL 32610-0247, USA. bbradley@ufl.edu
Wajsman
Zev
Z
D004358:Drug Therapy; D006801:Humans; D009132:Muscles / Q000473:pathology*; D011878:Radiotherapy; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy*