What are the alternatives treatments to partial cystectomy for bladder cancer?

Updated: Apr 03, 2019
  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

In the United States, most young healthy patients with urothelial carcinoma are treated with radical cystectomy as the criterion standard treatment because of survival advantages seen in large series. [23]

Several other studies have been published using treatment protocols involving systemic chemotherapy or external beam radiation (XRT). Multimodality bladder-sparing therapy usually includes complete transurethral resection followed by induction chemotherapy/radiation, repeat urological evaluation (biopsies or repeat transurethral resection), and, afterwards, consolidation chemotherapy/radiation. Salvage cystectomy is offered to patients without response to induction therapy or if recurrence is detected.

Table 2. Options Other than Partial Cystectomy (Open Table in a new window)

Study

Number of Patients

Induction Therapy

% Complete Response

Consolidation Therapy

% Overall Survival (years)

% Overall Survival with Bladder Intact (years)

Housset et al

120

Bifractionated XRT + concurrent cisplatin + 5-fluorouracil

77

Bifractionated XRT + concurrent 5-fluorouracil + cisplatin

63 (5)

 

...

Sauer et al

184

45-54 Gy XRT + concurrent cisplatin or carboplatin

80

None

56 (5)

41 (5)

Fellin et al

56

2 cycles MCVa, 40 Gy XRT + concurrent cisplatin

50

24 Gy XRT + concurrent cisplatin

55 (5)

41 (5)

Tester et al

49

40 Gy XRT + concurrent cisplatin

66

24 Gy XRT + concurrent cisplatin

60 (4)

42 (4)

Tester et al

91

2 cycles MCV, 39.6 Gy XRT + concurrent cisplatin

75

25.2 Gy XRT + concurrent cisplatin

62 (4)

44 (4)

Shipley et al

61

2 cycles MCVa, 39.6 Gy XRT + concurrent cisplatin

61

25.2 Gy XRT + concurrent cisplatin

48 (5)

36 (5)

Shipley et al

62

39.6 Gy XRT + concurrent cisplatin

55

25.2 Gy XRT + concurrent cisplatin

49 (5)

40 (5)

Kachnic et al

106

2 cycles MCV, 40 Gy XRT + concurrent cisplatin

66

24.8 Gy XRT + concurrent cisplatin

52 (5)

43 (5)

Zietman et al

18

Bifractionated XRT + concurrent cisplatin + 5-fluorouracil

78

Bifractionated XRT + concurrent cisplatin + 5-fluorouracil + 3 cycles MCV

83 (3)

78 (3)

a Methotrexate, cisplatin, and vinblastine [24]

Multimodality bladder-sparing approaches other than partial cystectomy yield 5-year overall survival rates of 48-56%, with 5-year bladder survival rates of 36-43%. Comparison between approaches is difficult because of the multiple variables which may affect survival differ significantly between study populations. To date, no prospective randomized studies among modalities have been performed, so data must be interpreted accordingly.

The most important factors for bladder-sparing therapies include appropriate patient selection and long-term surveillance. Patient factors that increase risk of failure in transurethral resection/chemoradiation protocols include clinical stage higher than T2, associated ureteral obstruction with hydroureteronephrosis, incomplete initial transurethral resection, multiple tumors, and lack of response to induction chemoradiation. Local recurrence rates for such protocols vary from 20-30%. A recent editorial estimated that the mortality risk of certain bladder sparing procedures was between 7-16%. [25]


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