Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Bladder-sparing therapy for muscle-infiltrating bladder cancer

Nature Clinical Practice Urology volume 5, pages 368–375 (2008)Cite this article

Abstract

Radical cystectomy is the treatment of choice for nonmetastatic, muscle-infiltrating bladder cancer. Several researchers have proposed the use of a bladder-sparing approach in carefully selected patients. Strict selection criteria and close follow-up are needed for bladder-preservation protocols. Although repeated transurethral resection of bladder tumors or partial cystectomy might be offered to high-risk patients, combined protocols with transurethral resection of bladder tumors and chemotherapy, with or without additional radiotherapy, seem to provide the best results, with 5-year survival rates of about 50%. Even if the chance of preserving the bladder is appealing, and despite evidence of some promising results, these protocols should still be considered investigative because, as yet, there are no randomized trials available that compare cystectomy with bladder-sparing surgery.

Key Points

  • Radical cystectomy is still the standard treatment for muscle-infiltrating bladder cancer

  • Bladder-sparing protocols for muscle-infiltrating bladder cancer should be applied in referral centers, with collaboration between urologists, oncologists and radiotherapists

  • Only very few patients are candidates for partial cystectomy, and they must be willing to comply with the strict surveillance required for bladder-sparing treatment

  • Repeated transurethral resection of bladder tumors is only suitable for a small percentage of very high-risk patients

  • A multimodality approach with chemoradiotherapy is probably the best available bladder-sparing option

  • In selected patients, oncological results of bladder sparing may be equivalent to those of radical cystectomy, but it must be clear that the comparison is between different groups

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Nishiyama H et al. (2004) Clinical outcome of a large-scale multi-institutional retrospective study for locally advanced bladder cancer: a survey including 1,131 patients treated during 1990–2000 in Japan. Eur Urol 45: 176–181

    Article  Google Scholar 

  2. Madersbacher S et al. (2003) Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol 21: 690–696

    Article  Google Scholar 

  3. Stein JP et al. (2001) Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 19: 666–675

    Article  CAS  Google Scholar 

  4. Grob MB and Fair WR (2001) Partial cystectomy in the treatment of urologic and non-urologic malignancies. AUA Update Series XX: 185–192

    Google Scholar 

  5. Sternberg CN et al. (2003) Can patient selection for bladder preservation be based on response to chemotherapy? Cancer 97: 1644–1652

    Article  Google Scholar 

  6. Herr HW and Scher HI (1994) Neoadjuvant chemotherapy and partial cystectomy for invasive bladder cancer. J Clin Oncol 12: 975–980

    Article  CAS  Google Scholar 

  7. Kassouf W et al. (2006) Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the MD Anderson Cancer Center experience. J Urol 175: 2058–2062

    Article  Google Scholar 

  8. O'Flynn JD et al. (1975) Transurethral resection for the assessment and treatment of vesical neoplasms: a review of 840 consecutive cases. Eur Urol 1: 38–40

    CAS  PubMed  Google Scholar 

  9. Barnes RW et al. (1977) Survival following transurethral resection of bladder carcinoma. Cancer Res 37: 2895–2898

    CAS  PubMed  Google Scholar 

  10. Herr HW (2001) Transurethral resection of muscle-invasive bladder cancer: 10-year outcome. J Clin Oncol 19: 89–93

    Article  CAS  Google Scholar 

  11. Solsona E et al. (1998) Feasibility of transurethral resection for muscle infiltrating carcinoma of the bladder: long-term followup of a prospective study. J Urol 159: 95–99

    Article  CAS  Google Scholar 

  12. Cowan RA et al. (2004) Radiotherapy for muscle-invasive carcinoma of the bladder: results of a randomized trial comparing conventional whole bladder with dose-escalated partial bladder radiotherapy. Int J Radiat Oncol Biol Phys 59: 197–207

    Article  Google Scholar 

  13. Hayter CR et al. (1999) A population-based study of the use and outcome of radical radiotherapy for invasive bladder cancer. Int J Radiat Oncol Biol Phys 45: 1239–1459

    Article  CAS  Google Scholar 

  14. Abe T and Kanehira C (1999) Factors influencing treatment results of definitive radiotherapy following transurethral surgery for muscle-invasive bladder cancer [Japanese]. Nippon Igaku Hoshasen Gakkai Zasshi 59: 516–520

    CAS  PubMed  Google Scholar 

  15. Nieuwenhuijzena JA et al. (2005) Survival after bladder preservation with brachytherapy versus radical cystectomy: a single institution experience. Eur Urol 48: 239–245

    Article  Google Scholar 

  16. de Crevoisier R et al. (2004) Bladder-conserving surgery and interstitial brachytherapy for lymph node negative transitional cell carcinoma of the urinary bladder: results of a 28-year single institution experience. Radiother Oncol 72: 147–157

    Article  Google Scholar 

  17. Schlosser J et al. (1997) Conservative surgery and iridium 192 in stage pT2 bladder tumor. A 5-year follow up [French]. Prog Urol 7: 953–959

    CAS  PubMed  Google Scholar 

  18. Wijnmaalen A et al. (1997) Muscle invasive bladder cancer treated by transurethral resection, followed by external beam radiation and interstitial iridium-192. Int J Radiat Oncol Biol Phys 39: 1043–1052

    Article  CAS  Google Scholar 

  19. Thomas DJ et al. (1999) Radical transurethral resection and chemotherapy in the treatment of muscle-invasive bladder cancer: a long-term follow-up. BJU Int 83: 432–437

    Article  CAS  Google Scholar 

  20. Angulo JC et al. (1996) Primary cisplatin, methotrexate and vinblastine aiming at bladder preservation in invasive bladder cancer: multivariate analysis on prognostic factors. J Urol 155: 1897–1902

    Article  CAS  Google Scholar 

  21. Herr HW et al. (1998) Neoadjuvant chemotherapy and bladder sparing surgery for invasive bladder cancer: ten-year outcome. J Clin Oncol 16: 1298–1301

    Article  CAS  Google Scholar 

  22. Sternberg CN et al. (2003) Can patient selection for bladder preservation be based on response to chemotherapy. Cancer 97: 1644–1652

    Article  Google Scholar 

  23. Srougi M and Simon SD (1994) Primary methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy and bladder preservation in locally invasive bladder cancer: a 5-year follow-up. J Urol 151: 593–597

    Article  CAS  Google Scholar 

  24. de la Rosa F et al. (2002) Primary cisplatin, methotrexate and vinblastine chemotherapy with selective bladder preservation for muscle invasive carcinoma of the bladder: long-term followup of a prospective study. J Urol 167: 2413–2418

    Article  CAS  Google Scholar 

  25. Kachnic LA et al. (1997) Bladder preservation by combined modality therapy for invasive bladder cancer. J Clin Oncol 15: 1022–1029

    Article  CAS  Google Scholar 

  26. Arias F et al. (2000) Chemoradiotherapy for muscle invading bladder carcinoma: final report of a single institutional organ-sparing program. Int J Radiat Oncol Biol Phys 47: 373–378

    Article  CAS  Google Scholar 

  27. Shipley WU et al. (2002) Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer. Urology 60: 62–67

    Article  CAS  Google Scholar 

  28. Danesi DT et al. (2004) Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy: long term results. Cancer 101: 2540–2548

    Article  Google Scholar 

  29. Birkenhake S et al. (1998) Radiotherapy alone or radiochemotherapy with platin derivatives following transurethral resection of the bladder: organ preservation and survival after treatment of bladder cancer. Strahlenther Onkol 174: 121–127

    Article  CAS  Google Scholar 

  30. Kaufman DS et al. (2005) RTOG Protocol 99-06: initial report of a phase I/II trial of selective bladder-conservation employing TURBT, accelerated irradiation sensitized with cisplatin and paclitaxel followed by ASCO 2005. Proc Annu Meet Am Soc Clin Oncol 23: S379

    Google Scholar 

  31. Tester W et al. (1993) Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12. Int J Radiation Oncology Biol Phys 25: 783–790

    Article  CAS  Google Scholar 

  32. Housset M et al. (1993) Combined radiation and chemotherapy for invasive transitional-cell carcinoma of the bladder: a prospective study. J Clin Oncol 11: 2150–2157

    Article  CAS  Google Scholar 

  33. Fellin G et al. (1997) Combined chemotherapy and radiation with selective organ preservation for muscle-invasive bladder carcinoma: a single-institution phase II study. Br J Urol 80: 44–49

    Article  CAS  Google Scholar 

  34. Prie L et al. (1998) Conservative treatment of infiltrating cancer of the bladder: neoadjuvant chemotherapy and radiotherapy. Cancer Radiother 2: 62–66

    Google Scholar 

  35. Cervek J et al. (1998) Invasive bladder cancer: our experience with bladder sparing approach. Int J Radiat Oncol Biol Phys 41: 273–278

    Article  CAS  Google Scholar 

  36. Vikram B et al. (1998) Rapidly alternating chemotherapy and radiotherapy instead of cystectomy for the treatment of muscle-invasive carcinoma of the urinary bladder: long term results of a pilot study. Cancer 82: 918–922

    Article  CAS  Google Scholar 

  37. Serretta V et al. (1998) The fate of patients with locally advanced bladder cancer treated conservatively with neoadjuvant chemotherapy, extensive transurethral resection and radiotherapy: 10-year experience. J Urol 159: 1187–1191

    Article  CAS  Google Scholar 

  38. Radosevic-Jelic L et al. (1999) Concomitant radiotherapy and carboplatin in locally advanced bladder cancer. Eur Urol 36: 401–405

    Article  CAS  Google Scholar 

  39. Olsburgh J and Whelan P (1999) Contemporary results of radical radiotherapy for bladder transitional cell carcinoma in a district general hospital. BJU Int 84: 1117

    CAS  PubMed  Google Scholar 

  40. Hagan MP et al. (2003) RTOG 97-06: initial report of a phase I-II trial of selective bladder conservation using TURBT, twice-daily accelerated irradiation sensitized with cisplatin, and adjuvant MCV combination chemotherapy. Int J Radiat Oncol Biol Phys 57: 665–672

    Article  Google Scholar 

  41. Hussain SA et al. (2004) Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer. Br J Cancer 90: 2106–2111

    Article  CAS  Google Scholar 

  42. George L et al. (2004) Clinical outcome in patients with locally advanced bladder carcinoma treated with conservative multimodality therapy. Urology 64: 488–493

    Article  Google Scholar 

  43. Sanchez-Ortiz RF et al. (2003) An interval longer than 12 weeks between the diagnosis of muscle invasion and cystectomy is associated with worse outcome in bladder carcinoma. J Urol 169: 110–115

    Article  Google Scholar 

  44. May M et al. (2004) Significance of the time period between diagnosis of muscle invasion and radical cystectomy with regard to the prognosis of transitional cell carcinoma of the urothelium in the bladder. Urol Nephrol 38: 231–235

    Article  CAS  Google Scholar 

  45. Chang SS et al. (2003) Delaying radical cystectomy for muscle invasive bladder cancer results in worse pathological stage. J Urol 170: 1085–1087

    Article  Google Scholar 

  46. Hautmann RE (1998) Complications and results after cystectomy in male and female patients with locally invasive bladder cancer. Eur Urol 33: 23–24

    Article  Google Scholar 

  47. Osen I et al. (1998) Prognostic factors in muscle-invasive bladder cancer treated with radiotherapy: an immunohistochemical study. Br J Urol 81: 862–869

    Article  CAS  Google Scholar 

  48. Michaelson MD et al. (2004) Selective bladder preservation for muscle-invasive transitional cell carcinoma of the urinary bladder. Br J Cancer 90: 578–581

    Article  CAS  Google Scholar 

  49. Matos T et al. (2000) Prognostic factors in invasive bladder carcinoma treated by combined modality protocol (organ-sparing approach). Int J Radiat Oncol Biol Phys 46: 403–409

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. V Pansadoro is the Director of the Vincenzo Pansadoro Foundation, Rome, Italy.,

    Vito Pansadoro

  2. P Emiliozzi is Senior Urologist at San Giovanni Hospital, Rome, Italy.,

    Paolo Emiliozzi

Authors
  1. Vito Pansadoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Emiliozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vito Pansadoro.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pansadoro, V., Emiliozzi, P. Bladder-sparing therapy for muscle-infiltrating bladder cancer. Nat Rev Urol 5, 368–375 (2008). https://doi.org/10.1038/ncpuro1145

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro1145

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing