Judy Hamad1, Hannah McCloskey2, Matthew I Milowsky3, Trevor Royce4, Angela Smith5. 1. University of North Carolina at Chapel Hill School of Medicine; Chapel Hill, NC, USA. 2. 2 Department of Urology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA. 3. Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA. 4. Department of Radiation Oncology, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA. 5. Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill; Chapel Hill, NC, USA.
Abstract
BACKGROUND: Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life. OBJECTIVE: To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. MATERIALS AND METHODS: We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. DISCUSSION: The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. CONCLUSIONS: This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care. Copyright® by the International Brazilian Journal of Urology.
BACKGROUND: Standard management of muscle-invasive bladder cancer involves radical cystectomy with pelvic lymph node dissection. However, patients may be ineligible for surgery or may wish to avoid the morbidity of cystectomy due to quality of life concerns. Bladder preservation therapies have emerged as alternatives treatment options that can provide comparable oncologic outcomes while maintaining patients' quality of life. OBJECTIVE: To review bladder preservation therapies, patient selection criteria, and functional and oncologic outcomes for BPT in muscle-invasive bladder cancer. MATERIALS AND METHODS: We conducted a comprehensive literature review of bladder preservation therapies in Pubmed and Embase. DISCUSSION: The ideal patient for BPT has low-volume T2 disease, absence of CIS, absence of hydronephrosis, and a maximal TURBT with regular surveillance. Technological advancements involving cancer staging, TURBT technique, and chemotherapy and radiation therapy regimens have improved BPT outcomes, with oncologic outcomes now comparable to those of radical cystectomy. Advancements in BPT also includes a heightened focus on improving quality of life for patients undergoing bladder preservation. Preservation strategies with most evidence for use include trimodality therapy and partial cystectomy with pelvic lymph node dissection. CONCLUSIONS: This review highlights the breadth of strategies that aim to preserve a patient's bladder while still optimizing local tumor control and overall survival. Future areas for innovation include the use of predictive biomarkers and implementation of immunotherapy, moving the field towards patient-tailored care. Copyright® by the International Brazilian Journal of Urology.
Authors: Fernando Korkes; Phillipe E Spiess; Herney Andres Garcia-Perdomo; Andrea Necchi Journal: Int Braz J Urol Date: 2022 May-Jun Impact factor: 3.050