Bladder-sparing treatment in muscle infiltrating carcinoma
Article published in Urologia Polska 2004/57/3.

authors

Tomasz Demkow

Klinika Nowotworów Układu Moczowego Centrum Onkologii - Instytut M. Curie-Skłodowskiej
Kierownik kliniki: dr hab. Tomasz Demkow

keywords

urinary bladder, transitional cell carcinoma, organ sparing treatment

summary

Bladder sparing treatment is applied as a routine in adenoarcinoma. It is not however widely accepted in transitional cell carcinoma. Many methods have been proposed to treat the neoplasm but sparing the bladder in the infiltrating muscular layer transitional cell carcinoma - e.g. transurethral deep electroresection, partial cystectomy, chemotherapy (CHTH), radiotherapy (EBRT), or radio-chemotherapy. The results are nor satisfactory: 5-year survival amounts to 46-63 percent, recurrence (superficial tumour 28-32 percent, advanced form 16-22 percent), bladder sparing 20-45 percent. Among advantages of organ sparing method are limitation of the surgical intervention, improved quality of life thanks to the preserved bladder and potency. Basic problems connected with a prolonged and complicated postoperative course consist of difficult preoperative grading the tumour, unacceptable toxic effects of chemotherapy (leading to withdrawal of drugs in 38 percent patients), necessity of constant control visits, local recurrences in 18-60% percent patients, high cost of treatment, ethical reservations and - last but not least - lack of randomized trials. The most difficult item in the bladder preserving treatment is the proper selection of patients. According to modern views, to obtain full recovery this form of treatment should be applied in a single, papillomatous bladder tumours grade pT2. Equally important is full response to CHTH and EBRT. The bladder preserving treatment should not be applied in carcinoma in situ, hydronephrosis and in the tumours not responding to CHTH and EBRT. Bladder sparring methods are applicable in a small group of patients suffering from transitional cell carcinoma of that organ, infiltrating its muscular layer.