Abstract
[Extract]
Muscle invasive bladder cancer (MIBC) is a life-threatening malignancy with a five-year overall survival of approximately 50 to 60%. Bladder cancer was the 14th leading cause of cancer death in the world in 2018, with approximately 200,000 deaths related to bladder cancer that year.
Traditionally, the cornerstone of curative treatment of MIBC is a radical cystectomy (RC), which involves the removal of the bladder, a pelvic lymph node dissection and reconstruction of the urinary tract. However, RC is associated with a significant perioperative mortality risk with high readmission rates, substantial morbidity and changes in patient’s quality of life (QOL).
Bladder conserving therapy (BCT) involves maximal cystoscopic resection of tumour followed by a combination of chemotherapy and radiation therapy. BCT achieves overall survival rates equal to that obtained with a RC, while preserving a patient’s bladder and with low rates of radiotherapy related toxicity. No randomised controlled trials have directly compared RC and BCT for MIBC. The SPARE randomised controlled trial attempted to make a direct comparison but due to poor recruitment was abandoned. Propensity-matched analyses suggest equivalent rates of cure and survival and international guidelines recommend BCT as a treatment option for selected patients.
Muscle invasive bladder cancer (MIBC) is a life-threatening malignancy with a five-year overall survival of approximately 50 to 60%. Bladder cancer was the 14th leading cause of cancer death in the world in 2018, with approximately 200,000 deaths related to bladder cancer that year.
Traditionally, the cornerstone of curative treatment of MIBC is a radical cystectomy (RC), which involves the removal of the bladder, a pelvic lymph node dissection and reconstruction of the urinary tract. However, RC is associated with a significant perioperative mortality risk with high readmission rates, substantial morbidity and changes in patient’s quality of life (QOL).
Bladder conserving therapy (BCT) involves maximal cystoscopic resection of tumour followed by a combination of chemotherapy and radiation therapy. BCT achieves overall survival rates equal to that obtained with a RC, while preserving a patient’s bladder and with low rates of radiotherapy related toxicity. No randomised controlled trials have directly compared RC and BCT for MIBC. The SPARE randomised controlled trial attempted to make a direct comparison but due to poor recruitment was abandoned. Propensity-matched analyses suggest equivalent rates of cure and survival and international guidelines recommend BCT as a treatment option for selected patients.
| Original language | English |
|---|---|
| Pages (from-to) | 882-893 |
| Number of pages | 12 |
| Journal | Journal of Medical Imaging and Radiation Oncology |
| Volume | 64 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Dec 2020 |
