Bladder Preservation Treatment for Urothelial Bladder Cancer
Bladder Preservation Treatment for Urothelial Bladder Cancer
Limited research evaluates transurethral resection of bladder tumor (TURBT) alone as curative treatment. However, in select patients with small, solitary tumors with focal invasion into the muscularis propria, longterm, bladder-intact survival rates of 60% to 70% have been reported. A large retrospective series of 432 patients referred for definitive management of muscle-invasive disease evaluated 151 patients who, after maximal TURBT, had either no residual or T1 stage disease. Ninety-nine patients were managed with active surveillance and 52 underwent radical cystectomy. The 10-year disease-free survival (DFS) rate was equivalent between the two groups, and 57% of those managed with surveillance retained their bladders. A subsequent phase II prospective trial of 133 patients treated with radical TURBT alone was performed. The inclusion criteria required no residual tumor after TURBT (T0), negative repeat biopsies of the tumor bed, and absence of hydronephrosis. In addition, the majority of patients had unifocal disease and no evidence of carcinoma in situ. The researchers found 10-year OS and bladderintact survival rates of 79% and 65%, respectively.
Despite these encouraging results, a separate retrospective review of 327 patients found that 35 patients (11%) were candidates for surveillance following TURBT. Of the 27 patients who opted for surveillance, 15 developed subsequent recurrence, with 8 undergoing radical cystectomy. Consequently, TURBT alone is best suited to patients with noninvasive (cTa or cTis) disease. If there is an incomplete resection or no muscle in the specimen, then a repeat TURBT should be performed.
Transurethral Resection of Bladder Tumor
Limited research evaluates transurethral resection of bladder tumor (TURBT) alone as curative treatment. However, in select patients with small, solitary tumors with focal invasion into the muscularis propria, longterm, bladder-intact survival rates of 60% to 70% have been reported. A large retrospective series of 432 patients referred for definitive management of muscle-invasive disease evaluated 151 patients who, after maximal TURBT, had either no residual or T1 stage disease. Ninety-nine patients were managed with active surveillance and 52 underwent radical cystectomy. The 10-year disease-free survival (DFS) rate was equivalent between the two groups, and 57% of those managed with surveillance retained their bladders. A subsequent phase II prospective trial of 133 patients treated with radical TURBT alone was performed. The inclusion criteria required no residual tumor after TURBT (T0), negative repeat biopsies of the tumor bed, and absence of hydronephrosis. In addition, the majority of patients had unifocal disease and no evidence of carcinoma in situ. The researchers found 10-year OS and bladderintact survival rates of 79% and 65%, respectively.
Despite these encouraging results, a separate retrospective review of 327 patients found that 35 patients (11%) were candidates for surveillance following TURBT. Of the 27 patients who opted for surveillance, 15 developed subsequent recurrence, with 8 undergoing radical cystectomy. Consequently, TURBT alone is best suited to patients with noninvasive (cTa or cTis) disease. If there is an incomplete resection or no muscle in the specimen, then a repeat TURBT should be performed.