Organ preservation by combined modality treatment in bladder cancer: the European perspective.

Combined modality therapy, including transurethral resection, radiation therapy, and systemic chemotherapy, has been shown to produce survival rates comparable to those of radical cystectomy. With these programs, cystectomy has been reserved for patients with incomplete response or local relapse after trimodality treatment. This review summarizes European series of combined modality treatment of muscle-invasive bladder cancer and reflects our emphasis on the importance of combining radiation with a transurethral resection and cisplatin-based chemotherapy. It also documents our belief that high-grade T1 disease may be effectively treated by the same approach. This represents a true distinction between the European and US strategies. We also review the role of predictive and prognostic factors in selecting patients for the respective treatment alternatives.