Radical cystectomy for stage T3b bladder cancer

Radical cystectomy with pelvic lymphadenectomy is the mainstay of treatment of muscle-invasive transitional cell carcinoma of the bladder. Outcome in patients with pathologically organ-confined disease is excellent, with local control rates exceeding 90% and 5-year survival approaching 80%. It is apparent, however, that radical cystectomy alone is inadequate therapy for patients with clinical or pathological extravesical extension. These patients are at high risk for relapse both locally and distantly. The development of more effective chemotherapy and optimal integration of systemic therapy with locally applied therapeutic modalities are needed. Recent data suggest that patients with clinical extravesical extension (T3b/T4) may benefit from combined local therapy with the addition of preoperative radiotherapy as well as multi-agent systemic chemotherapy. Furthermore, it appears that clinical staging modalities are reliable in the selection of patients for this multi-modal approach with only a small number of patients thereby subjected to unnecessary treatment.