Value of cemoradiation in bladder cancer

Radical cystectomy remains the standard of care for muscle-invasive bladder cancer, while for high-risk superficial carcinoma an organ-preserving approach, including transurethral resection (TUR) and intravesical therapy, is recommended. This review summarizes the chemotherapy and radiotherapy options for high risk T1 or muscle-invasive bladder cancer as alternative to or as neoadjuvant therapy before radical surgery. Multimodality therapy, including TUR, radiation and chemotherapy, is associated with recurrence and progression rates of 30% and 15% in high-risk T1 bladder cancer, respectively. For muscle-invasive disease, 5-year survival rates in the range of 50-60% have been published, which is comparable to primary cystectomy series. Approximately 80% of surviving patients retained their own well functioning bladder. Close coordination among all disciplines is required to achieve optimal results. An integral part of the concept is salvage cystectomy for non-responder or muscle-invasive recurrence. Ideal candidates for the organ preserving approach are those with early-stage unifocal tumors (T1/T2). Preoperative chemoradiation is likely to improve the results of cystectomy alone in patients with locally advanced bladder cancer (T3b, T4).