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Trimodal therapy in muscle invasive bladder cancer management
- Source :
- Polo-Alonso, Elvira; Kuk, Cynthia; Guruli, Georgi; Paul, Asit K; Thalmann, George; Kamat, Ashish; Solsona, Eduardo; Thalmann, George; Urdaneta, Alfredo I; Zlotta, Alexandre R; Mir, Maria C (2020). Trimodal therapy in muscle invasive bladder cancer management. Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 72(6), pp. 650-662. Edizioni Minerva Medica 10.23736/S0393-2249.20.04018-7
- Publication Year :
- 2020
- Publisher :
- Edizioni Minerva Medica, 2020.
-
Abstract
- INTRODUCTION Radical cystectomy (RC) is the current mainstay for muscle-invasive bladder cancer (MIBC). Concerns regarding morbidity, mortality and quality of life have favored the introduction of bladder sparing strategies. Trimodal therapy, combining transurethral resection, chemotherapy and radiotherapy is the current standard of care for bladder preservation strategies in selected patients with MIBC. EVIDENCE ACQUISITION A comprehensive search of the Medline and Embase databases was performed. A total of 19 studies were included in a systematic review of bladder sparing strategies in MIBC management was carried out following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). EVIDENCE SYNTHESIS The overall median complete response rate after trimodal therapy (TMT) was 77% (55-93). Salvage cystectomy rate with TMT was 17% on average (8-30). For TMT, the 5-year cancer-specific survival and overall survival rates range from 42-82% and 32-74%, respectively. Currently data supporting neoadjuvant or adjuvant chemotherapy in bladder sparing approaches are emerging, but robust definitive conclusions are still lacking. Gastrointestinal toxicity rates are low around 4% (0.5-16), whereas genitourinary toxicity rates reached 8% (1-24). Quality of life outcomes are still underreported. CONCLUSIONS Published data and clinical experience strongly support trimodal therapy as an acceptable bladder sparing strategy in terms of oncological outcomes and quality of life in selected patients with MIBC. A strong need exists for specialized centers, to increase awareness among urologists, to discuss these options with patients and to stress the increased participation of patients and their families in treatment path decision-making.
- Subjects :
- Oncology
medicine.medical_specialty
Urology
medicine.medical_treatment
030232 urology & nephrology
MEDLINE
610 Medicine & health
Cystectomy
03 medical and health sciences
0302 clinical medicine
Quality of life
Internal medicine
medicine
Humans
Neoplasm Invasiveness
Salvage Therapy
Chemotherapy
Bladder cancer
Genitourinary system
business.industry
Muscles
Patient Selection
Middle Aged
medicine.disease
Combined Modality Therapy
Neoadjuvant Therapy
Survival Rate
Radiation therapy
Systematic review
Urinary Bladder Neoplasms
Chemotherapy, Adjuvant
Nephrology
030220 oncology & carcinogenesis
Quality of Life
Female
business
Organ Sparing Treatments
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Polo-Alonso, Elvira; Kuk, Cynthia; Guruli, Georgi; Paul, Asit K; Thalmann, George; Kamat, Ashish; Solsona, Eduardo; Thalmann, George; Urdaneta, Alfredo I; Zlotta, Alexandre R; Mir, Maria C (2020). Trimodal therapy in muscle invasive bladder cancer management. Minerva urologica e nefrologica = The Italian journal of urology and nephrology, 72(6), pp. 650-662. Edizioni Minerva Medica 10.23736/S0393-2249.20.04018-7 <http://dx.doi.org/10.23736/S0393-2249.20.04018-7>
- Accession number :
- edsair.doi.dedup.....ce5d4e7363e22a9e8e421f5aeaf382b3