TY - JOUR
T1 - Trimodal therapy in muscle invasive bladder cancer management
AU - Polo-Alonso, Elvira
AU - Kuk, Cynthia
AU - Guruli, Georgi
AU - Paul, Asit K.
AU - Thalmann, George
AU - Kamat, Ashish
AU - Solsona, Eduardo
AU - Thalmann, George
AU - Urdaneta, Alfredo I.
AU - Zlotta, Alexandre R.
AU - Mir, Maria C.
N1 - Publisher Copyright:
© 2020 Edizioni Minerva Medica
PY - 2020/12
Y1 - 2020/12
N2 - Introduction: radical cystectomy (rc) is the current mainstay for muscle-invasive bladder cancer (MiBc). concerns regarding morbidity, mortality and quality of life have favored the introduction of bladder sparing strategies. Trimodal therapy, combining transurethral resection, chemotherapy and radiotherapy is the current standard of care for bladder preservation strategies in selected patients with MiBc. eviDence acQUiSiTion: a comprehensive search of the Medline and embase databases was performed. a total of 19 studies were included in a systematic review of bladder sparing strategies in MiBc management was carried out following the preferred reporting items for systematic reviews and meta-analysis (PriSMa). eviDence SYnTHeSiS: The overall median complete response rate after trimodal therapy (TMT) was 77% (55-93). Salvage cystectomy rate with TMT was 17% on average (8-30). For TMT, the 5-year cancer-specific survival and overall survival rates range from 42-82% and 32-74%, respectively. currently data supporting neoadjuvant or adjuvant chemotherapy in bladder sparing approaches are emerging, but robust definitive conclusions are still lacking. Gastrointestinal toxicity rates are low around 4% (0.5-16), whereas genitourinary toxicity rates reached 8% (1-24). Quality of life outcomes are still underreported. conclUSionS: Published data and clinical experience strongly support trimodal therapy as an acceptable bladder sparing strategy in terms of oncological outcomes and quality of life in selected patients with MiBc. a strong need exists for specialized centers, to increase awareness among urologists, to discuss these options with patients and to stress the increased participation of patients and their families in treatment path decision-making.
AB - Introduction: radical cystectomy (rc) is the current mainstay for muscle-invasive bladder cancer (MiBc). concerns regarding morbidity, mortality and quality of life have favored the introduction of bladder sparing strategies. Trimodal therapy, combining transurethral resection, chemotherapy and radiotherapy is the current standard of care for bladder preservation strategies in selected patients with MiBc. eviDence acQUiSiTion: a comprehensive search of the Medline and embase databases was performed. a total of 19 studies were included in a systematic review of bladder sparing strategies in MiBc management was carried out following the preferred reporting items for systematic reviews and meta-analysis (PriSMa). eviDence SYnTHeSiS: The overall median complete response rate after trimodal therapy (TMT) was 77% (55-93). Salvage cystectomy rate with TMT was 17% on average (8-30). For TMT, the 5-year cancer-specific survival and overall survival rates range from 42-82% and 32-74%, respectively. currently data supporting neoadjuvant or adjuvant chemotherapy in bladder sparing approaches are emerging, but robust definitive conclusions are still lacking. Gastrointestinal toxicity rates are low around 4% (0.5-16), whereas genitourinary toxicity rates reached 8% (1-24). Quality of life outcomes are still underreported. conclUSionS: Published data and clinical experience strongly support trimodal therapy as an acceptable bladder sparing strategy in terms of oncological outcomes and quality of life in selected patients with MiBc. a strong need exists for specialized centers, to increase awareness among urologists, to discuss these options with patients and to stress the increased participation of patients and their families in treatment path decision-making.
KW - Chemoradiotherapy
KW - Organ sparing treatments
KW - Therapeutics
KW - Urinary Bladder
KW - Urinary bladder neoplasms
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U2 - 10.23736/S0393-2249.20.04018-7
DO - 10.23736/S0393-2249.20.04018-7
M3 - Review article
C2 - 33263367
AN - SCOPUS:85097210181
SN - 0393-2249
VL - 72
SP - 650
EP - 662
JO - Minerva Urologica e Nefrologica
JF - Minerva Urologica e Nefrologica
IS - 6
ER -