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Multimodality Treatment for Bladder Conservation

  • Oliver J. Ott
Living reference work entry

Abstract

Standard treatment for muscle-invasive urothelial cancer of the bladder is radical cystectomy. Multimodality treatment, including initial transurethral resection of the bladder tumor (TUR-B), followed by concurrent radiochemotherapy (RCT) has been shown to produce survival rates comparable to those of radical cystectomy. With these bladder conservation approaches, (salvage) cystectomy has been reserved for patients with incomplete response or local muscle-invasive relapse. During the past three decades, organ preservation by multimodality treatment has been investigated in prospective series from single centers and cooperative groups, with far more than 1000 patients included. Five-year overall survival rates in the range of 50–60% have been reported, and approximately 80% of the surviving patients maintained their own bladder. Clinical criteria helpful in determining patients for bladder preservation include such variables as small tumor size (<5 cm), early tumor stage, a visibly and microscopically complete transurethral resection, absence of ureteral obstruction, and no evidence of pelvic lymph node metastases. On multivariate analysis, the completeness of TUR-B was found to be one of the strongest predictive factors for overall survival. Patients at greater risk of recurrence after initial complete response are those with multifocal disease and extensive associated carcinoma in situ at presentation. Close coordination among all disciplines is required to achieve optimal results. Future investigations will focus on optimizing radiation techniques including all possibilities of radiosensitization (e.g., concurrent radiochemotherapy, additional deep regional hyperthermia), and incorporating more effective systemic chemotherapy, and proper selection of patients based on predictive molecular makers.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversitätsklinikum ErlangenErlangenGermany

Section editors and affiliations

  • Wolfgang Otto
    • 1
  • Shahrokh F. Shariat
    • 2
  1. 1.der Universität RegensburgOberarzt der Klinik für UrologieRegensburgGermany
  2. 2.Departement of UrologyWeill Cornell Medical CenterNew YorkUSA

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