The standard treatment for muscle-invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy. Primary organ-preservation by means of multimodal therapy, however, can be a viable alternative to radical surgery.
The concept and results of multimodal therapy, consisting of initial transurethral resection of the bladder tumor (TUR-B), followed by simultaneous radiochemotherapy (RCT), are presented.
Evaluation of retrospective cohorts and prospective therapy optimization studies on organ-preservation treatment regimens. Comparative meta-analyses comparing cystectomy with multimodal treatment are presented.
Complete TUR-B, including bladder mapping and tumor biopsy, should precede simultaneous RCT. Radiosensitization should be cisplatin-based or consist of a combination of 5‑fluorouracil and mitomycin C. Complete response rates after TUR-B plus RCT are generated in 60-90% of patients along with 5‑year survival rates of 40-75% and preservation of the bladder in approximately 80% of surviving patients.
Multimodal therapy by means of TUR-B followed by simultaneous RCT is a viable alternative to radical cystectomy for patients with muscle-invasive urinary bladder carcinoma. Patients with early tumors (cT2/3N0) are particularly suitable in whom initial TUR-B leads to complete tumor resection (R0).
Der Urologe. Ausg. A. 2018 Apr 12 [Epub ahead of print]
N Tselis, F J Prott, O Ott, C Weiss, C Rödel
Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland. ., , Wiesbaden, Deutschland., Universitätsklinikum Erlangen, Erlangen, Deutschland., Klinikum Darmstadt, Darmstadt, Deutschland., Universitätsklinikum Frankfurt, Frankfurt, Deutschland.