What are the NCCN recommendations for the treatment of muscle-invasive bladder disease?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

NCCN recommendations for treatment of muscle-invasive disease are as follows  [1] :

  • TURBT is the initial diagnostic procedure after CT/MRI imaging of the abdomen, pelvis, and in some cases the chest, to help identify the clinical stage of the bladder cancer.

  • Radical cystectomy is the primary treatment for all muscle-invasive disease, with strong consideration for cisplatin-based neoadjuvant chemotherapy (category 1 recommendation), especially for patients with hydronephrosis, vascular/lymphatic invasion, extravesical disease, or aberrant histologic variants.

  • Neoadjuvant chemotherapy may be preferred over adjuvant chemotherapy; however, there are no data to support this preference.

  • Regimens include DDMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) with growth factor support for three or four cycles; gemcitabine and cisplatin for three or four cycles (both 21- and 28-day regimens are acceptable); or accelerated-dose MVAC for three cycles.

  • The NCCN panel prefers DDMVAC over standard MVAC, based on category 1 evidence that DDMVAC is better tolerated and more effective than conventional MVAC in advanced disease.

  • Partial cystectomy may be performed in highly selected patients with a solitary lesion in a suitable location and no CIS or previous tumors; cisplatin-based neoadjuvant chemotherapy should be considered.

  • Bladder preservation following TURBT with concurrent chemotherapy and radiation is an alternative therapy for patients with multiple medical co-morbidities or who refuse radical cystectomy; the decision should be based, in part, on the location, size and depth of invasion, and absence of hydronephrosis, as well as the bladder capacity, function, and comorbidities.


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