To discuss the evidence for bladder preservation in localized muscle-invasive bladder cancer (MIBC) and the critical role of systemic treatments in enhancing outcomes.
Key Findings:
Trimodality therapy shows equivalent or superior disease control compared to radical cystectomy (RC), highlighting its potential as a primary treatment option.
Long-term survival rates for TMT are comparable to RC, with 5-year overall survival rates around 50%, indicating its effectiveness.
Retrospective analyses indicate equivalent outcomes for patients receiving either RC or TMT, suggesting the viability of both approaches.
Hypofractionated radiotherapy regimens demonstrate superior locoregional control with comparable toxicity rates, supporting their use in clinical practice.
Interpretation:
Both radical cystectomy and bladder-preservation strategies should be presented as viable treatment options for MIBC, empowering patients to make informed decisions based on their preferences and values.
Limitations:
A randomized control trial comparing RC to bladder-preservation failed due to recruitment challenges, limiting the strength of direct comparisons.
Retrospective analyses may have inherent biases, which could affect the reliability of the outcomes reported.
Conclusion:
Bladder preservation strategies, particularly trimodality therapy, are effective alternatives to radical cystectomy for localized MIBC, supported by emerging evidence and advancements in radiotherapy techniques, emphasizing the need for patient-centered treatment discussions.
