[Radiochemotherapeutic options for bladder cancer]

Abstract

Radical cystectomy remains the standard of care for muscle-invasive bladder cancer, while for high-risk superficial carcinoma an organ-preserving approach, including transurethral resection (TUR) and intravesical therapy, is recommended. This review summarizes the radiochemotherpeutic options for high risk T1 or muscle-invasive bladder cancer - as an alternative for/or neoadjuvant therapy before radical surgery. Multimodality therapy, including TUR, radiation, and chemotherapy, is associated with recurrence and progression rates of 30 % and 15 %, respectively, in high-risk T1 bladder cancer. For muscle-invasive disease, five-year survival rates in the range of 50 % to 60 % have been published, which is comparable to primary cystectomy series. Approximately 80 % of the surviving patients maintained their own, well functioning bladder. Close coordination among all disciplines is required to achieve optimal results. An integral part of the concept is salvage cystectomy for non-responders or muscle-invasive recurrences. Ideal candidates for the organ-preserving approach are those with early-stage unifocal tumours (T1/T2). Preoperative radiochemotherapy is likely to improve the results of cystectomy alone in patients with locally advanced bladder cancer (T3b, T4).