|Year : 2018 | Volume
| Issue : 2 | Page : 84-89
Bladder preservation protocols in the management of muscle-invasive bladder cancer: A systematic review
Srikanth Pentyala1, RB Nerli2, Shridhar C Ghagane3, Murigendra B Hiremath4
1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, Karnataka, India
2 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University); KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru Nagar, Belagavi, Karnataka, India
3 Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
4 Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
|Date of Web Publication||10-Dec-2018|
Shridhar C Ghagane
Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and M.R.C, Nehru Nagar, Belagavi - 590 010, Karnataka
Source of Support: None, Conflict of Interest: None
Bladder cancer is one of the most common cancers worldwide causing a significant burden on healthcare system and society. Muscle-invasive bladder cancer (MIBC) is highly fatal, and if untreated, >85% of patients die within 2 years of diagnosis. Although radical cystectomy (RC) is the preferred treatment of choice in patients with MIBC, bladder preservation can be considered in patients who are either not eligible for cystectomy or are not willing to undergo cystectomy. The goal of bladder preservation is to achieve cancer survival at least equivalent to RC and to maintain better quality of life including sexual function. Strategies for bladder preservation include partial cystectomy, radical transurethral resection, radiation therapy, and chemotherapy. It is widely accepted that combination of these approaches could result in better outcomes in patients with MIBC. In this review, we describe different approaches for bladder preservation and their outcomes.
Keywords: Bladder preservation therapy, muscle-invasive bladder cancer, partial cystectomy, trimodal therapy
|How to cite this article:|
Pentyala S, Nerli R B, Ghagane SC, Hiremath MB. Bladder preservation protocols in the management of muscle-invasive bladder cancer: A systematic review. J Sci Soc 2018;45:84-9
|How to cite this URL:|
Pentyala S, Nerli R B, Ghagane SC, Hiremath MB. Bladder preservation protocols in the management of muscle-invasive bladder cancer: A systematic review. J Sci Soc [serial online] 2018 [cited 2019 May 26];45:84-9. Available from: http://www.jscisociety.com/text.asp?2018/45/2/84/247151
| Introduction|| |
Bladder cancer is the ninth most common cancer worldwide, with 430,000 newly diagnosed cases in 2012. It significantly contributes to the burden on healthcare system and society and affects quality of life of the patient. More than half of patients with bladder cancer and more than half of all bladder cancer deaths are reported from less developed countries. Overall, there is strong male predominance with three-fourth cases reported in males. Bladder cancer is the seventh most common cancer in men and the nineteenth most common cancer in women worldwide. The worldwide incidence of bladder cancer in men was around 4.5%, and the mortality rate is 2.6%; however, the incidence and mortality rate are 1.5% and 1.2%, respectively, in women. In India, bladder cancer is the twelfth most common cancer in men and the nineteenth most common cancer in women.
Histologically, the majority (>90%) of bladder cancers are urothelial carcinomas and squamous cell carcinoma that contribute to 5% of cases and adenomatous carcinoma to 3% of the cases. Around 70%–80% of de novo bladder cancers are diagnosed in early stages (Ta, Tis, and T1) with no muscular invasion; however, one-fifth of these cases will progress to muscle invasion. Muscle-invasive bladder cancer (MIBC) is highly fatal, and if untreated, >85% of patients die within 2 years of diagnosis. Under staging of bladder cancer is not uncommon and is one of the reasons contributing to increased mortality.
| Treatment Options|| |
Treatment of bladder cancer depends on the stage of the lesion. In early-stage bladder cancer (Ta, T1, and carcinoma in situ), transurethral resection of bladder tumor (TURBT) is the most commonly used modality followed by adjuvant intravesical administration of Bacillus Calmette–Guérin in patients with high-grade disease. The extent of disease and the type of surgery have direct impact on the overall outcome of MIBC. Once cancer invades bladder wall (stage T2 onward), called as MIBC, TURBT is typically the first-line treatment primarily performed to determine the extent of invasion rather than to treat cancer. In patients with MIBC (stage T2–T4a, N0, and M0), radical cystectomy (RC) and pelvic lymph node dissection are the gold standard treatments. Several clinical studies and series have demonstrated the usefulness and long-term outcomes of RC. In some cases, neoadjuvant/adjuvant chemotherapy is given before surgery, particularly in cases with T4a and T4b.
In one of the largest series, 1054 patients with MIBC who underwent RC with bilateral pelvic iliac lymphadenectomy between July 1971 and December 1997 showed overall recurrence-free survival of 68% and 66% at 5 and 10 years, respectively, for the entire cohort. In patients with organ-confined, lymph node-negative tumors (P0, Pis, Pa, and P1), the 5-year recurrence-free survival was 92%, 91%, 79%, and 83%, respectively, and 10-year recurrence-free survival was 86%, 89%, 74%, and 78%, respectively. Patients with stage P2 and P3a with negative lymph node had 89% and 87% and 78% and 76% at 5- and 10-year recurrence-free survival, respectively. This rate was 62% and 61% for P3b tumors and 50% and 45% for P4 tumors, respectively. Another study by Goodney et al. showed that RC has the second highest readmission rate compared to other urological or nonurological procedures. In patients who are not eligible for cystectomy or patients who are not willing to undergo cystectomy, bladder preservation can be considered. It is important that patients and their relatives are made aware of the fact that cystectomy may impact sexual and bowel functions.
| Bladder Preservation|| |
The goal of bladder preservation is to achieve cancer survival at least equivalent to RC and to maintain good quality of life including sexual life. According to the American Urological Association 2017 guideline (AUA/ASCO/ASTRO/SUO guideline) “for patients with newly diagnosed nonmetastatic MIBC who desire to retain their bladder and for those with significant comorbidities for whom RC is not a treatment option, clinicians should offer bladder-preserving therapy when clinically appropriate.”
Strategies for bladder preservation include partial cystectomy, radical transurethral resection, radiation, and chemotherapy. It is widely accepted that combination of these approaches could result in the best outcomes in patients with MIBC. Hence, bladder preservation could include single modality treatment or trimodal therapy. Single modality bladder preservation techniques include radical transurethral resection (TUR), chemotherapy, or radiotherapy alone; however, trimodal therapy includes complete TUR, chemotherapy, and radiotherapy.
Several series have demonstrated that single modality bladder preservation has inferior outcomes compared to trimodal bladder preservation approach. Hence, it is important to carefully select the patient for bladder preservation evaluating risk and benefits, and patients who are medically fit to undergo cystectomy should be offered cystectomy. [Table 1] summarizes selection criteria for bladder preservation.
In contrast, some studies have demonstrated inferior outcomes among patients who underwent bladder preservation than those who had RC. In a recent study by Cohn et al., they evaluated 32,300 patients from the National Cancer Database who underwent bladder preservation (n = 9620) or RC (n = 22,680) for MIBC, and overall results showed that bladder preservation was associated with decreased overall survival (OS) compared with RC in patients with stage II–III urothelial carcinoma.
| Radical Transurethral Resection|| |
Transurethral resection is primarily used in patients with T2 bladder cancer. Although the usability of TUR is questioned considering the presence of local microfocus extensions and digital tumor spread in several cases, few studies have demonstrated benefits of TUR in small selected population.,, In a study by Herr, 10-year outcome of patients with MIBC treated by TUR alone was evaluated, and the results showed that the disease-specific survival was 76% in patients who received TUR as definitive therapy compared with patients who immediate cystectomy (71%). A total of 82% of patients who had T0 on restaging TUR survived versus 57% of the patients who had residual T1 tumor on restaging TUR.
Another report of 133 patients with MIBC (grade 2/3) who underwent TUR from April 1981 to September 1992 and patients followed up for 15 years showed the OS at 5, 10, and 15 years was 81.9%, 79.5%, and 76.7% and progression-free survival with bladder preservation was 75.5%, 64.9%, and 57.8%, respectively.
| Partial Cystectomy|| |
The advantage of partial cystectomy is that it allows complete resection of the cancerous lesion with wide surgical margins and helps maintain bladder and sexual function. Partial cystectomy also allows full dissection of pelvic lymph node and removal of full thickness, which help a surgeon in complete staging. An ideal patient for partial cystectomy is one who has a solitary lesion (<5 cm) present in a region which can be removed with adequate margin. Patients who have multiple lesions, concomitant carcinoma in situ, or defunctionalized or acontractile bladders are not suitable for partial cystectomy.,
When partial cystectomy is planned, it is important that patients are counseled before surgery for possible RC in cases where negative margin is not achieved. Furthermore, the surgeon must consider that during lymph node dissection, the borders must be similar to that of RC. Outcomes can be reasonable for carefully selected patient. In a population-based study, the 5-year OS was 57.2% and cause-specific survival was 76.4% in patients who were treated with partial cystectomy; however, these rates were 50.2% and 65.8%, respectively, among patients treated with RC (P < 0.001). When cohorts were matched for age, race, pT stage, pN stage, tumor grade, and year of surgery, the OS and cause-specific survival were still significantly (P < 0.05) higher in patients treated with RC; however, when the number of removed lymph nodes was added to the matching criteria, the OS and cause-specific survival were similar in both the groups (P > 0.05). Overall, the authors concluded that partial cystectomy does not undermine cancer control in carefully selected patients. Several other studies have also demonstrated the OS between 50% and 70% for patients undergoing partial cystectomy for MIBC.,,,,,
| Radiotherapy|| |
Radiotherapy is an alternative treatment which has reasonably decent results among patients who are very weak or unfit for other treatment options or for those who refuse operation. Conventional radiotherapy in combination with chemotherapy, or alone, may result in better outcomes in locally advanced bladder cancer patients. However, a limitation of radiotherapy is that dose cannot be reduced to critical organs which may cause unavoidable adverse effects. Radiotherapy is generally administered 1.8–2 Gy per day fractions and a total dose of 45–50 Gy is delivered to the pelvis and 55–70 Gy to the bladder tumor bed.
A population-based study evaluated the outcome of radical radiotherapy. This study assessed 20,906 new cases of bladder cancer diagnosed between 1982 and 1994, of which 1372 patients received radical radiotherapy. The results from this study showed 5-year survival rates as follows: bladder cancer cause-specific, 41%; overall, 28%; cystectomy-free, 25%; bladder cancer cause-specific following salvage cystectomy, 36%; overall following salvage cystectomy, 28%. In a study by Chung et al., 340 patients (T1–T4) were treated, between 1986 and 1997, with radiotherapy alone, radiotherapy and concurrent cisplatin chemotherapy, or neoadjuvant chemotherapy followed by radiotherapy. Complete response rate was 63.5% for the whole group. The 10-year OS, cause-specific survival, and local relapse-free rates were 19%, 35%, and 32%, respectively. Authors also reported that younger patients and patients with early stage and absence of carcinoma in situ were associated with significant improvement in survival and local control. Kotwal et al. compared outcomes between patients receiving either RC or radiotherapy between 1996 and 2000 and found that there was no difference in OS and cause-specific and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older.
| Chemotherapy|| |
Chemotherapy in patients with MIBC can be neoadjuvant or adjuvant primarily given before RC. There are a number of studies and meta-analyses that have demonstrated that neoadjuvant chemotherapy before RC improves survival.,,,, In an initial study that was conducted over an 11-year period, a total of 317 patients with MIBC (stage T2 to T4a) who received neoadjuvant chemotherapy (three cycles of methotrexate, vinblastine, doxorubicin, and cisplatin) before the treatment of RC. The results showed that the median survival was 46 months in patients who were treated with RC alone, as compared with 77 months in patients who received neoadjuvant before chemotherapy RC. In addition, significantly higher number of patients who received neoadjuvant chemotherapy before RC had no residual disease.
A recent meta-analysis of 15 randomized clinical trials compared neoadjuvant chemotherapy plus local treatment with the same local treatment alone in patients with MIBC and found that cisplatin-based neoadjuvant chemotherapy had better OS benefit (hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.79–0.96). The meta-analysis also evaluated the benefits comparing methotrexate, vinblastine, doxorubicin, and cisplatin versus gemcitabine and cisplatin/carboplatin using 13 retrospective studies and found that there is no difference in pathological complete response in both the regimen; however, gemcitabine and cisplatin/carboplatin significantly reduced OS (HR, 1.26; 95% CI, 1.01–1.57), and when these data were analyzed excluding carboplatin data, gemcitabine and cisplatin were found to be inferior to patients who received methotrexate, vinblastine, doxorubicin, and cisplatin. Another meta-analysis evaluated the role of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer using data from 14 studies and found that patients in the neoadjuvant chemotherapy group had similar OS (pooled HR 0.92, 95% CI: 0.84–1.00, P = 0.056) and progression-free survival (P = 0.725) to that observed in radiation therapy or cystectomy. Overall, authors concluded that the platinum-based neoadjuvant chemotherapy was associated with similar survival benefit as patients undergoing cystectomy and/or radiotherapy. Based on the available literature, it seems to be still debatable whether all patients with MIBC should be treated with chemotherapy.
| Trimodal Therapy|| |
Trimodal therapy includes TUR followed by concurrent chemoradiation. It is primarily reserved for two types of patients, one those who are medically unfit for RC and second for those who meet strict criteria for curative intent. An ideal patient for trimodal therapy presents with unifocal cT2N0M0 urothelial carcinoma of the bladder, good bladder function and capacity, no carcinoma in situ, no infiltration of prostatic stroma, and no hydronephrosis, which represents 15% of current RC patients.
In general, a patient selected for trimodal therapy undergo a maximal, preferably visually complete TUR, ideally with bladder mapping, followed by the delivery of cisplatin-based chemoradiotherapy to a dose of approximately 40–45 Gy. After this, final consolidative phase of chemotherapy is initiated in patients with evidence of minimal residual disease or no disease, and in patients with progressive or unresponsive disease, RC is considered. Although there are no randomized controlled trials comparing trimodal therapy versus RC, several retrospective and prospective studies have confirmed the effectiveness of trimodal therapy in patients with MIBC and an alternative to RC. [Table 2] summarizes outcomes among patients with MIBC treated with trimodal therapy.,,,,,,,
|Table 2: Summary of few recent studies reporting trimodal/combination therapy|
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A recent systematic review and meta-analysis assessed trimodal therapy and RC for the treatment of MIBC with or without neoadjuvant chemotherapy and included a total of 57 studies including 30,293 patients. The results showed that the mean 10-year OS and disease-specific survival were 30.9% and 50.9%, respectively, for trimodal therapy and 35.1% and 57.8%, respectively, for RC (P > 0.05).
Mak et al. pooled five phase II studies and one phase III study from prospective Radiation Therapy Oncology Group protocols in patients with MIBC (T2 = 61%, T3 = 35%, and T4a = 4%) and found that the OS at 5 years was 57% and at 10 years was 36%; disease-specific survival was 71% and 65% at 5 and 10 years, respectively. The muscle-invasive local failure and distant metastasis were 13% and 14% and 31% and 35%, respectively, at 5 and 10 years. Considering these results, authors concluded that combined modality can be considered as an alternative to RC, particularly in elderly patients who are not fit for surgery.
The basic strategy of trimodal therapy is to combine an aggressive but safe transurethral resection of the tumor followed by concurrent chemotherapy and radiotherapy. Trimodal treatment is more an attempt at bladder preservation than definitive bladder preservation. In the continuous course, cystoscopic assessment with adequate biopsy of the previous tumor site and voided urine cytology is performed at completion of trimodal therapy or after induction in the split course. In case of incomplete response, patients are advised to undergo immediate RC. To date, no prospective study has compared both courses (continuous versus split). Induction therapy mainly consists of radiation to a dose of 40 Gy. Consolidation radiation is continued to a full dose of approximately 65 Gy in most trials. In the continuous course strategy, cystoscopic evaluation with biopsy is deferred up to 1–3 months after the end of TMT.,
In a study by Kim et al., outcomes among 50 patients who received RC and 29 patients who received trimodal therapy were compared and found 58%, 56%, and 69% 5-year distant metastasis-free survival, OS, and cancer-specific survival, respectively, in RC group and 67%, 57% and 63%, respectively, in trimodal therapy group.
| Conclusion|| |
The goal of bladder preservation is to achieve cancer survival at least equivalent to RC and to maintain quality of life including sexual life. Based on the available literature, it is evident that carefully selected patients can benefit from bladder preservation. Hence, it is important to carefully select the patient for bladder preservation evaluating risk and benefits. Bladder preservation can be achieved using single modality treatment; however, patients undergoing trimodal therapy have better outcomes.
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Conflicts of interest
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| References|| |
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al.
Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F, et al.
Bladder cancer incidence and mortality: A global overview and recent trends. Eur Urol 2017;71:96-108.
el-Mekresh M, Akl A, Mosbah A, Abdel-Latif M, Abol-Enein H, Ghoneim MA, et al.
Prediction of survival after radical cystectomy for invasive bladder carcinoma: Risk group stratification, nomograms or artificial neural networks? J Urol 2009;182:466-72.
Guzzo TJ, Vaughn DJ. Management of metastatic and invasive bladder cancer. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh Urology. 11th
ed. Philadelphia, PA: Saunders/Elsevier; 2012. p. 2223-41.
Prout GR, Marshall VF. The prognosis with untreated bladder tumors. Cancer 1956;9:551-8.
Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al.
Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1,054 patients. J Clin Oncol 2001;19:666-75.
Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003;238:161-7.
Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al.
Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol 2017;198:552-9.
Premo C, Apolo AB, Agarwal PK, Citrin DE. Trimodality therapy in bladder cancer: Who, what, and when? Urol Clin North Am 2015;42:169-80, vii.
Cahn DB, Handorf EA, Ghiraldi EM, Ristau BT, Geynisman DM, Churilla TM, et al.
Contemporary use trends and survival outcomes in patients undergoing radical cystectomy or bladder-preservation therapy for muscle-invasive bladder cancer. Cancer 2017;123:4337-45.
Herr HW. Transurethral resection of muscle-invasive bladder cancer: 10-year outcome. J Clin Oncol 2001;19:89-93.
Solsona E, Iborra I, Ricós JV, Monrós JL, Casanova J, Calabuig C. Feasibility of transurethral resection for muscle infiltrating carcinoma of the bladder: Long-term followup of a prospective study. J Urol 1998;159:95-8.
Solsona E, Iborra I, Collado A, Rubio-Briones J, Casanova J, Calatrava A. Feasibility of radical transurethral resection as monotherapy for selected patients with muscle invasive bladder cancer. J Urol 2010;184:475-80.
Smelser WW, Austenfeld MA, Holzbeierlein JM, Lee EK. Where are we with bladder preservation for muscle-invasive bladder cancer in 2017? Indian J Urol 2017;33:111-7.
] [Full text]
Capitanio U, Isbarn H, Shariat SF, Jeldres C, Zini L, Saad F, et al.
Partial cystectomy does not undermine cancer control in appropriately selected patients with urothelial carcinoma of the bladder: A population-based matched analysist. Urology 2009;74:858-64.
Knoedler JJ, Boorjian SA, Kim SP, Weight CJ, Thapa P, Tarrell RF, et al.
Does partial cystectomy compromise oncologic outcomes for patients with bladder cancer compared to radical cystectomy? A matched case-control analysis. J Urol 2012;188:1115-9.
Kassouf W, Swanson D, Kamat AM, Leibovici D, Siefker-Radtke A, Munsell MF, et al.
Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: A contemporary review of the M. D. Anderson cancer center experience. J Urol 2006;175:2058-62.
Ma B, Li H, Zhang C, Yang K, Qiao B, Zhang Z, et al.
Lymphovascular invasion, ureteral reimplantation and prior history of urothelial carcinoma are associated with poor prognosis after partial cystectomy for muscle-invasive bladder cancer with negative pelvic lymph nodes. Eur J Surg Oncol 2013;39:1150-6.
Holzbeierlein JM, Lopez-Corona E, Bochner BH, Herr HW, Donat SM, Russo P, et al.
Partial cystectomy: A contemporary review of the memorial Sloan-Kettering cancer center experience and recommendations for patient selection. J Urol 2004;172:878-81.
Smaldone MC, Jacobs BL, Smaldone AM, Hrebinko RL Jr. Long-term results of selective partial cystectomy for invasive urothelial bladder carcinoma. Urology 2008;72:613-6.
Fahmy N, Aprikian A, Tanguay S, Mahmud SM, Al-Otaibi M, Jeyaganth S, et al.
Practice patterns and recurrence after partial cystectomy for bladder cancer. World J Urol 2010;28:419-23.
Moonen L, vd Voet H, de Nijs R, Horenblas S, Hart AA, Bartelink H, et al.
Muscle-invasive bladder cancer treated with external beam radiation: Influence of total dose, overall treatment time, and treatment interruption on local control. Int J Radiat Oncol Biol Phys 1998;42:525-30.
Hayter CR, Paszat LF, Groome PA, Schulze K, Math M, Mackillop WJ. A population-based study of the use and outcome of radical radiotherapy for invasive bladder cancer. Int J Radiat Oncol Biol Phys 1999;45:1239-45.
Chung PW, Bristow RG, Milosevic MF, Yi QL, Jewett MA, Warde PR, et al.
Long-term outcome of radiation-based conservation therapy for invasive bladder cancer. Urol Oncol 2007;25:303-9.
Kotwal S, Choudhury A, Johnston C, Paul AB, Whelan P, Kiltie AE. Similar treatment outcomes for radical cystectomy and radical radiotherapy in invasive bladder cancer treated at a United Kingdom specialist treatment center. Int J Radiat Oncol Biol Phys 2008;70:456-63.
Grossman HB, Natale RB, Tangen CM, Speights VO, Vogelzang NJ, Trump DL, et al.
Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003;349:859-66.
Kitamura H, Tsukamoto T, Shibata T, Masumori N, Fujimoto H, Hirao Y, et al.
Randomised phase III study of neoadjuvant chemotherapy with methotrexate, doxorubicin, vinblastine and cisplatin followed by radical cystectomy compared with radical cystectomy alone for muscle-invasive bladder cancer: Japan clinical oncology group study JCOG0209. Ann Oncol 2014;25:1192-8.
Yin M, Joshi M, Meijer RP, Glantz M, Holder S, Harvey HA, et al.
Neoadjuvant chemotherapy for muscle-invasive bladder cancer: A systematic review and two-step meta-analysis. Oncologist 2016;21:708-15.
Winquist E, Kirchner TS, Segal R, Chin J, Lukka H; Genitourinary Cancer Disease Site Group, Cancer Care Ontario Program in Evidence-based Care Practice Guidelines Initiative. Neoadjuvant chemotherapy for transitional cell carcinoma of the bladder: A systematic review and meta-analysis. J Urol 2004;171:561-9.
Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: Update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol 2005;48:202-5.
Li G, Niu HM, Wu HT, Lei BY, Wang XH, Guo XB, et al.
Effect of cisplatin-based neoadjuvant chemotherapy on survival in patients with bladder cancer: A meta-analysis. Clin Invest Med 2017;40:E81-94.
Mathieu R, Lucca I, Klatte T, Babjuk M, Shariat SF. Trimodal therapy for invasive bladder cancer: Is it really equal to radical cystectomy? Curr Opin Urol 2015;25:476-82.
Kim YJ, Byun SJ, Ahn H, Kim CS, Hong BS, Yoo S, et al.
Comparison of outcomes between trimodal therapy and radical cystectomy in muscle-invasive bladder cancer: A propensity score matching analysis. Oncotarget 2017;8:68996-9004.
Mitin T, Hunt D, Shipley WU, Kaufman DS, Uzzo R, Wu CL, et al.
Transurethral surgery and twice-daily radiation plus paclitaxel-cisplatin or fluorouracil-cisplatin with selective bladder preservation and adjuvant chemotherapy for patients with muscle invasive bladder cancer (RTOG 0233): A randomised multicentre phase 2 trial. Lancet Oncol 2013;14:863-72.
James ND, Hussain SA, Hall E, Jenkins P, Tremlett J, Rawlings C, et al.
Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med 2012;366:1477-88.
Tunio MA, Hashmi A, Qayyum A, Mohsin R, Zaeem A. Whole-pelvis or bladder-only chemoradiation for lymph node-negative invasive bladder cancer: Single-institution experience. Int J Radiat Oncol Biol Phys 2012;82:e457-62.
Efstathiou JA, Spiegel DY, Shipley WU, Heney NM, Kaufman DS, Niemierko A, et al.
Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: The MGH experience. Eur Urol 2012;61:705-11.
Kaufman DS, Winter KA, Shipley WU, Heney NM, Wallace HJ 3rd
, Toonkel LM, et al.
Phase I-II RTOG study (99-06) of patients with muscle-invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice-daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology 2009;73:833-7.
Perdonà S, Autorino R, Damiano R, De Sio M, Morrica B, Gallo L, et al.
Bladder-sparing, combined-modality approach for muscle-invasive bladder cancer: A multi-institutional, long-term experience. Cancer 2008;112:75-83.
Kaufman DS, Winter KA, Shipley WU, Heney NM, Chetner MP, Souhami L, et al.
The initial results in muscle-invading bladder cancer of RTOG 95-06: Phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5-fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist 2000;5:471-6.
Fahmy O, Khairul-Asri MG, Schubert T, Renninger M, Malek R, Kübler H, et al.
Asystematic review and meta-analysis on the oncological long-term outcomes after trimodality therapy and radical cystectomy with or without neoadjuvant chemotherapy for muscle-invasive bladder cancer. Urol Oncol 2018;36:43-53.
Mak RH, Hunt D, Shipley WU, Efstathiou JA, Tester WJ, Hagan MP, et al.
Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: A pooled analysis of radiation therapy oncology group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol 2014;32:3801-9.
Nerli RB, Reddy M, Koura AC, Prabha V, Ravish IR, Amarkhed S. Cystoscopy-assisted laparoscopic partial cystectomy. J Endourol 2008;22:83-6.
Ploussard G, Daneshmand S, Efstathiou JA, Herr HW, James ND, Rödel CM, et al.
Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: A systematic review. Eur Urol 2014;66:120-37.
[Table 1], [Table 2]