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What is the role of radiotherapy in bladder-preserving cancer therapy?

Nature Clinical Practice Oncology volume 2, pages 4–5 (2005)Cite this article

Treatment of invasive bladder cancer remains a triple challenge: first, the eradication of local disease, second, the elimination of potential micrometastases, and, third, the maintenance of the best quality of life. The gold standard for the treatment of muscle-invasive disease is radical cystectomy. Sophisticated techniques for urinary diversion have been developed to improve patients' quality of life. Even the construction of a neobladder with continent urinary diversion, however, cannot substitute for the patient's original bladder. Attempts to achieve organ preservation are only justified when they have a high likelihood of achieving local cure with no compromise in survival rates. Neither transurethral resection of the bladder tumor (TURBT), chemotherapy, nor radiotherapy can achieve adequate local control when used alone. Several groups have reported the value of combining all three modalities, with salvage cystectomy being reserved for patients with incomplete response or local relapse.

The centers that pioneered modern bladder preservation therapy included Harvard University in the US; the University of Paris in France; and the University of Erlangen in Germany. In the 1980s, studies at Harvard under the auspices of the US National Bladder Cancer Group showed that irradiation of the bladder tumor could be safely combined with cisplatin in patients who were considered not to be candidates for cystectomy.1 In 1988, Housset et al. from the University of Paris began a prospective trial of preoperative radiochemotherapy, using 5-fluorouracil (5-FU) and cisplatin with concomitant radiation therapy, followed by cystectomy or additional radiochemotherapy.2 Complete responders were considered candidates for bladder preservation and salvage cystectomy was restricted to patients with an incomplete response after induction therapy. With 120 patients included in this trial between 1988 and 1995, the percentage of patients that achieved a complete pathologic response was 77% and the 5-year survival was 63%.3 In 1990, Sauer et al. from the University of Erlangen reported the results of a phase II study of cisplatin with concomitant radiotherapy after TURBT in 67 patients with invasive bladder cancer.4 Complete response was obtained in 75% of patients and overall 3-year survival was 66%. Over the past years, the concept of organ preservation by combined modality treatment has been investigated in several prospective series from single centers and cooperative groups, with more than 1,000 patients included. Five-year overall survival rates in the range of 50%–60% have been reported and about 75% of the surviving patients maintained their own bladder.

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Authors and Affiliations

  1. Attending Physician and Associate Professor of Radiation Therapy,

    Claus Rödel & Rolf Sauer

  2. Department of Radiation Therapy at the University of Erlangen, Germany

    Claus Rödel & Rolf Sauer

Authors
  1. Claus Rödel
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  2. Rolf Sauer
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Correspondence to Claus Rödel.

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The authors declare no competing financial interests.

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Rödel, C., Sauer, R. What is the role of radiotherapy in bladder-preserving cancer therapy?. Nat Rev Clin Oncol 2, 4–5 (2005). https://doi.org/10.1038/ncponc0052

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