Chemo for Muscle-Invasive Bladder Cancer

Lindsey

Although radiation has been the mainstay of nonsurgical treatment of muscle-invasive transitional cell carcinoma of the bladder for more than 50 years, cure rates have been disappointing, with 5-year survival in the range of only 30–50%. Factors contributing to the disappointing survival rates include the reduced certainty of defining the true extent of the tumor (because of noninvasive staging techniques), the selection of patients with a poorer prognosis (patients treated with radiation tend to be older and/or with other medical comorbidities) and the fact that most high grade, invasive bladder cancers have already seeded occult metastases by the time of initial presentation. The use of radiotherapy for this indication has, therefore, declined.

In the US, radical cystectomy with bilateral pelvic lymph-node dissection is considered to be the gold standard for treating muscle-invasive bladder cancer, despite the fact that, to date, no definitive randomized phase III trial has compared a modern protocol of cystectomy with radical radiotherapy (perhaps with salvage cystectomy).

The combined-modality treatment concept was introduced to enhance local tumor control. Initially, this involved radiotherapy (to achieve tumor downstaging) followed by cystectomy or the use of deep transurethral resection of invasive bladder cancer, followed by radiotherapy. Neither of these approaches seems to improve survival in a meaningful way. The apparent antitumor activity of systemic chemotherapy in the metastatic setting has led to the exploration of this modality in muscle-invasive disease in combination with standard locoregional definitive treatment.

Several strategies that combine systemic chemotherapy and radiation therapy have been explored in the management of muscle-invasive bladder cancer, and these strategies have yielded better local control results than single modality therapy.

http://www.nature.com/ncponc/journal...cponc1159.html