Treatment options for high-risk T1 bladder cancer: status quo and future perspectives of radiochemotherapy.
OBJECTIVE
To review the standards and new developments in diagnosis and management of high-risk T1 bladder cancer with emphasis on the role of radiotherapy (RT) and radiochemotherapy (RCT).


METHODS
A systematic review of the literature on developments in diagnosis and management of high-risk T1 bladder cancer was performed.


RESULTS
First transurethral resection (TUR), as radical as safely possible, supported by fluorescence cystoscopy, shows higher detection and decreased recurrence rates. An immediate single postoperative instillation with a chemotherapeutic drug reduces the relative risk of recurrence by 40%. A second TUR is recommended to assess residual tumor. For adjuvant intravesical therapy, bacille Calmette-Guérin (BCG) demonstrated the highest efficacy. Early cystectomy should be reserved for selected patients. A recent phase III trial comparing RT versus conservative treatment in T1 G3 tumors could not show any advantage for RT. Data from Erlangen, Germany, using combined RCT in 80% of the patients, compare favorably with most of the contemporary BCG series.


CONCLUSIONS
Results of intravesical therapy are still unsatisfying and early cystectomy is associated with morbidity and mortality. RT alone proved not superior to other conservative treatment strategies. However, data on RCT are promising and demonstrate an alternative to intravesical therapy and radical cystectomy.
Weiss
Christian
C
Department of Radiation Oncology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. Christian.Weiss@kgu.de
Ott
Oliver J
OJ
Wittlinger
Michael
M
Krause
Steffen F
SF
Fietkau
Rainer
R
Sauer
Rolf
R
Rödel
Claus
C
D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D015653:Cystectomy; D003558:Cystoscopy; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
D001500:BCG Vaccine