Trimodal therapy for muscle-invasive bladder cancer

ABSTRACT

Introduction: Radical cystectomy is the standard therapy for patients with muscle-invasive bladder cancer. Organ-preserving surgical procedures have been established as alternatives to radical surgery for localized malignancies in other anatomic sites. Trimodal therapy consisting of radiation therapy, chemotherapy, and either transurethral resection of the bladder or partial cystectomy is an effective treatment for selected patients with muscle-invasive bladder cancer that allows for preservation of the urinary bladder.

Areas covered: This review provides an overview of the value of trimodal therapy in the treatment of muscle-invasive bladder cancer.

Expert commentary: Prerequisites for trimodal therapy for bladder cancer include: good bladder function, unifocal cT2 urothelial carcinoma of the bladder, and absence of hydronephrosis. Careful selection of patients and accurate assessment of the anatomic extent of the tumor is important for patient safety. The basis for successful trimodal therapy is complete transurethral resection of the tumor, followed by radiation therapy with concurrent radiosensitizing chemotherapy. Cystoscopic controls and follow-up biopsies should be performed at completion of adjuvant therapy or shortly after induction of trimodal therapy to identify nonresponders for whom salvage radical cystectomy may be indicated.

KEYWORDS:

• Chemotherapy
• cystectomy
• muscle-invasive bladder cancer
• radiation
• trimodal therapy
• TURB

Declaration of interest

A Stenzl reports acting as a consultant or member of the advisory board for Ipsen Pharma, Roche, Janssen, Alere and Bristol-Myers Squibb. They also report being a speaker on behalf of Janssen, Ipsen Pharma, Sanofi Aventis, CureVac, and Astellas. A Stenzl also reports receiving institutional funding from Johnson & Johnson, Roche, Cepheid, Amgen Inc, Bayer AG, CureVac, Immatics Biotechnologies GmbH, Novartis AG and Karl Storz AG. T Todenhoefer reports acting as a consultant for Ipsen Pharma and Roche Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.