Muscle-Invasive Bladder Cancer That Did Not Achieve Complete Response After Trimodality Therapy
Clinical Scenario
This protocol addresses patients with muscle-invasive bladder cancer presenting as a solitary, unifocal cT2–T3a tumour, with absence of extensive or multifocal carcinoma in situ, no or unilateral hydronephrosis, and good baseline bladder function — the profile for which bladder-preserving trimodality therapy is indicated.
Prior Treatment — Goal Not Reached
The prior-line approach was trimodality therapy: maximal transurethral resection of bladder tumour followed by concurrent chemoradiation using external beam radiotherapy with concurrent radiosensitising chemotherapy (cisplatin, mitomycin-C plus 5-FU, or gemcitabine). The intended goal — complete response with intact bladder — was not achieved. This failure of response is what escalates management to the present protocol.
Next-Line Approach (Overview)
For patients with invasive bladder cancer recurrence after trimodality therapy, a surgical salvage intervention forms the basis of this protocol and can be curative in appropriate candidates.
Complete eligibility criteria, the full decision algorithm, and procedural detail are in the structured protocol below.
References
- Trimodality therapy is best suited for patients with solitary, unifocal cT2-T3a tumours, absence of extensive or multifocal CIS, no or unilateral hydronephrosis, and good baseline bladder function.
- Trimodality therapy should also be considered for patients medically unfit or unwilling to undergo RC.
- Offer salvage cystectomy to patients with muscle-invasive bladder cancer recurrence after trimodality therapy.
- In contemporary series, salvage cystectomy is required in approximately 10-15% of patients treated with TMT due to invasive in-bladder recurrences and can be curative.
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