Radical cystectomy with pelvic lymph node dissection is the standard treatment for patients with invasive bladder cancer. However, many alternative techniques to spare the bladder have been investigated.
Methods
We review the experience reported in the literature on bladder-sparing techniques, including transurethral resection, chemotherapy, and radiation for muscle-invasive disease.
Results
Most comparative studies indicate that local recurrence and survival outcomes for bladder-sparing approaches are inferior to those from radical cystectomy to control muscle-invasive bladder cancer.
Conclusions
Although molecular biologic techniques may have the capacity to identify a subgroup who may benefit from a bladder-sparing approach, cystectomy is normally required for optimal results.
ShipleyW.U., KaufmanD.S., HeneyN.M.An update of combined modality therapy for patients with muscle invading bladder cancer using selective bladder preservation or cystectomy.J Urol.1999; 162: 445–451.
3.
SternbergC.N., YagodaA., ScherH.I.Preliminary results of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for transitional cell carcinoma of the urothelium.J Urol.1985; 133: 403–407.
4.
GschwendJ.E., ViewegJ., FaivW.R.. Contemporary results of radical cystectomy for primary bladder cancer. Lesson 13.AUA Update Series.1999; 18.
5.
WajsmanZ., RifkinM.N.. Alternative therapies for muscle-invasive transitional cell carcinoma.Probl Urol.1992; 6: 493–505.
HenryK., MillerJ., MoriM.Comparison of transurethral resection to radical therapies for stage B bladder tumors.J Urol.1988; 140: 964–967.
8.
SolsonaE., IborraI., RicosJ.V.Feasibility of transurethral resection for muscle infiltrating carcinoma of the bladder: prospective study.J Urol.1992; 147: 1513–1515.
9.
SolsonaE., IborraI., RicosJ.V.Feasibility of transurethral resection for muscle infiltrating carcinoma of the bladder: long-term follow-up of a prospective study.J Urol.1998; 159: 95–99.
10.
WhitmoreW.F.. Selection of treatment for muscle infiltrating transitional cell bladder cancer.Arch Esp Urol.1990; 43: 219–222.
11.
HerrH.W.. The value of a second transurethral resection in evaluating patients with bladder tumors.J Urol.1999; 162: 74–76.
12.
SweeneyP., KurshE.D., ResnickM.I.. Partial cystectomy.Urol Clin North Am.1992; 19: 701–711.
13.
GivenR.E., WajsmanZ.. Bladder sparing treatments for muscle invasive transitional cell carcinoma of the bladder. Lesson 6.AUA Update Series.1997; 16.
14.
NovickA.C., StewardB.H.. Partial cystectomy in the treatment of primary and secondary carcinoma of the bladder.J Urol.1976; 116: 570–574.
15.
FaysalM.H., FreihaF.S.. Evaluation of partial cystectomy for bladder cancer.Urology.1979; 14: 352.
16.
MerrellR.W., BrownH.E., RoseJ.F.. Bladder carcinoma treated by partial cystectomy: a review of 54 cases.J Urol.1979; 122: 471–472.
17.
LindahlF., JorgensenD., EgvadK.. Partial cystectomy for transitional cell carcinoma of the bladder.Scand J Nephrol.1984; 18: 125–129.
18.
KanetiJ.. Partial cystectomy in the management of bladder carcinoma.Eur Urol.1986; 12: 249–252.
19.
WessonM.F.. Radiation therapy in regionally advanced bladder cancer.Urol Clin North Am.1992; 19: 725–734.
20.
HolmangS., HedelinH., BorghedeG.Long-term followup of a bladder carcinoma cohort: questionable value of radical radiotherapy.J Urol.1997; 157: 1642–1646.
21.
MontieJ.E.. Against bladder sparing: surgery.J Urol.1999; 162: 452–457.
22.
EapenL., StewartD., CrookJ.Intraarterial cisplatin (IAC) and concurrent pelvic radiation (PR) in the management of transitional bladder cancer: an organ preservation strategy.Proc Annu Meet Am Soc Clin Oncol.1995; 14: A625.
23.
WijnmaalenA., HelleP.A., KoperP.C.Muscle invasive bladder cancer treated by transurethral resection followed by external beam radiation and interstitial iridium-192.Int J Radiat Oncol Biol Phys.1997; 39: 1043–1052.
24.
MillerL.S.. Bladder cancer: superiority of preoperative irradiation and cystectomy in clinical stages B2 and C.Cancer.1977; 39(2 suppl): 973–980.
25.
ScherH.I., YagodaA., HerrH.W.Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) affect on the primary bladder lesion.J Urol.1987; 139: 470–474.
26.
HerrH.W., ScherH.I.. Neoadjuvant chemotherapy and partial cystectomy for invasive bladder cancer.J Clin Oncol.1994; 12: 975–980.
27.
SternbergC.N., ArenaM.G., CalabresiF.Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) for infiltrating transitional cell carcinoma of the bladder.Cancer.1993; 72: 1975–1982.
28.
HatcherP.A., HahnR.G., RichardsonR.L.Neoadjuvant chemotherapy for invasive bladder carcinoma: disease outcome and bladder preservation and relationship to local tumor response.Eur Urol.1994; 25: 209–215.
29.
ScattoniV., Da PozzoL., NavaL.Five-year results of neoadjuvant cisplatin, methotrexate and vinblastine chemotherapy plus radical cystectomy in locally advanced bladder cancer.Eur Urol.1995; 28: 102–107.
30.
HerrH.W., BajorinD.F., ScherH.I.Can p53 help select patients with invasive bladder cancer for bladder preservation?J Urol.1999; 161: 20–23.
31.
SternbergC.N.. Gemcitabine in bladder cancer.Semin Oncol.2000; 27(1 suppl 2): 31–39.
32.
KaufmanD., StadlerW., CarducciM.Gemcitabine (GEM) plus cisplatin (CDDP) in metastatic transitional cell carcinoma (TCC): final results of a phase II study.Proc Annu Meet Am Soc Clin Oncol.1998; 17: A1235.
33.
ShipleyW.U., ProutG.R.Jr, EinsteinA.B.Treatment of invasive bladder cancer by cisplatin and radiation in patients unsuited for surgery.JAMA.1987; 258: 931–935.
34.
KachnicL.A., KaufmanD.S., HeneyN.M.Bladder preservation by combined modality therapy for invasive bladder cancer.J Clin Oncol.1997; 15: 1022–1029.
35.
GivenR.W., ParsonsJ.T., McCarleyD.Bladder-sparing multimodality treatment of muscle-invasive bladder cancer: a five-year follow-up.Urology.1995; 46: 499–505.
36.
DunstJ., SauerR., SchrottK.M.Organ-sparing treatment of advanced bladder cancer: a 10-year experience.Int J Radiat Oncol Biol Phys.1994; 30: 261–266.
37.
TesterW., PorterA., AsbellS.Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12.Int J Radiat Oncol Biol Phys.1993; 25: 783–790.
38.
ShipleyW.U., WinterK.A., KaufmanD.S.Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03.J Clin Oncol.1998; 16: 3576–3583.
39.
HoussettM., DufourE., Maulard-DurduxC.. Concomitant fluorouracil (5-FU)-cisplatin (CDDP) and bifractionated split course radiation therapy (BSCRT) for invasive bladder cancer.Proc Annu Meet Am Soc Clin Oncol.1997; 16: A1139.
40.
SrougiM., SimonS.D.. Primary methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy and bladder preservation in locally invasive bladder cancer: a 5-year followup.J Urol.1994; 151: 593–597.
41.
SternbergC.N., RaghavenD., OhiY.Neoadjuvant and adjuvant chemotherapy in advanced disease: what are the effects on survival and prognosis?Int J Urol.1995; 2(suppl 2): 76–88.
42.
SkinnerD.G., LieskovskyG.. Management of invasive and high-grade bladder cancer. In: SkinnerD.G., LieskovskyG., eds. Diagnosis and Management of Genitourinary Cancer.Philadelphia, Pa: WB Saunders Co; 1988: 295–312.
43.
GschwendJ.E., ViewegJ., FairW.R.. Disease specific survival after radical cystectomy.J Urol.1997; 157: 1662A.
44.
ChengL., NeumannR.M., SchererB.G.Tumor size predicts the survival of patients with pathologic stage T2 bladder carcinoma: a critical evaluation of the depth of muscle invasion.Cancer.1999; 85: 2638–2647.
45.
BalajiK.C., McGuireM., GrotasJ.Upper tract recurrences following radical cystectomy: an analysis of prognostic factors, recurrence pattern and stage at presentation.J Urol.1999; 162: 1603–1606.
46.
SchwartzD.B., BekirovH., MelmanA.. Urothelial tumors of upper tract following treatment of primary bladder transitional cell carcinoma.Urology.1992; 40: 509–511.
47.
MalkowiczS.B., SkinnerD.G.. Development of upper tract carcinoma after cystectomy for bladder carcinoma.Urology.2000; 36: 20–22.
48.
KenworthyP., TanguayS., DinneyD.P.. The risk of upper tract recurrence following cystectomy in patients with transitional cell carcinoma involving the distal ureter.J Urol.1996; 155: 501–503.
49.
HerrH.W., CooksonM.S., SolowayS.M.. Upper tract tumors in patients with primary bladder cancer followed for 15 years.J Urol.1996; 156: 1286–1287.
50.
HerrH.W., DonatS.M.. Prostatic tumor relapse in patients with superficial bladder tumors: 15-year outcome.J Urol.1999; 161: 1854–1857.
51.
LittleF.A., HowardG.C.. Sexual function following radical radiotherapy for bladder cancer.Radiother Oncol.1998; 49: 157–161.
52.
HartS., SkinnerE.C., MeyerowitzB.E.Quality of life after radical cystectomy for bladder cancer in patients with an ileal conduit, cutaneous or urethral kock pouch.J Urol.1999; 162: 77–81.
53.
LernerS.P.. A phase I/II trial of transurethral surgery combined with concurrent cisplatin 5-fluorouracil and twice daily radiation followed by selective bladder preservation in operable patients with muscle invading bladder cancer: editorial comment.J Urol.1998; 160: 1677.
