Organ conservation in T2-3 bladder cancer: the role of transurethral resection, partial cystectomy, and primary and adjuvant chemotherapy

Summary

Although radical cystectomy is the accepted treatment for invasive bladder cancer, bladder-sparing techniques are more often being used. All current methods of bladder preservation are controversial. These include: transurethral resection (TUR) ± intravesical therapy, TUR + systemic chemotherapy, partial cystectomy, radiation therapy ± chemotherapy, and neoadjuvant chemotherapy without radical cystectomy. The urologist is guided by a number of criteria in selecting patients who may benefit from conservative therapy. The role of neoadjuvant and adjuvant therapy has not been fully established. Alone or in combination with radiation, chemotherapy can produce significant tumor regression of intravesical and locoregional transitional cell carcinoma. In selected patients, those with T2 and T3a, bladder preservation can be a reasonable goal. Neoadjuvant therapy appears better tolerated than adjuvant therapy. Clinical downstaging occurs in 40–80% of cases, but this has not been substantiated pathologically. Bladder preservation can be achieved in selected cases, but survival remains the most important endpoint.