Is Bladder-Preserving Treatment For Me?
The gold standard approach to treating muscle-invasive bladder cancer is radical cystectomy, or removal of the bladder. Physicians use this approach because it drastically reduces the chances of the cancer spreading (metastasizing) to other organs.1 Most physicians consider a radical cystectomy a “curative approach” to bladder cancer.2
Options for bladder preservation
While the end goal of any cancer treatment is long-term control of the disease, physicians are also aware that bladder removal can greatly impact a patient’s quality of life (QOL) in many ways.1 Knowing this, researchers have been looking for a curative approach that will allow a patient to keep their own bladder if possible. Researchers in the United States and Europe have been studying a three-part approach to treating bladder cancer in the hopes that patients will be able to keep their bladder.1,2
The three-part approach
In this research therapy, patients are treated with surgery (transurethral resection), chemotherapy, and radiation therapy (trimodal therapy). Transurethral resection consists of a doctor removing the parts of the bladder affected by cancer. This surgery is done under general anesthesia, when a doctor inserts a small tube that contains a camera and cutting instrument into the bladder through the urethra to remove any visible tumors.3 Patients are then treated with a combination of the chemotherapy drugs methotrexate, cisplatin and vinblastine. The doses of these drugs vary throughout treatment depending on the side effects that the patients have. Finally the patients are treated with radiation therapy (an average of 64 Gr), or combination of simultaneous radio- and chemotherapies.
Meeting necessary criteria
In order to be eligible for this treatment, patients had to meet certain criteria. For example, their disease had to be in a certain stage, they had to have certain levels in their blood counts, and they could not have had a prior history of cancer.1,2 About 85% of patients experienced a complete response to treatment, meaning that they had no visible tumor, no microscopic tumor in biopsies, and no tumor cells in their urine. Overall, after five years, 56.3% of patients had no disease recurrence, and 70.5% of patients had no muscle-invasive disease relapse. About 20% of patients had to go on to have their bladder removed in order to be cancer free.1
Another study using the same approach looked at late occurring toxicities with the trimodal therapies. About 40% of patients experienced late toxicities of therapy, happening about 2-3 years (22-31 months) after treatment.2 These toxicities were all pelvic in nature, including diarrhea, bowel cramping, increased number of bowel movements, bowel obstruction or bleeding, and increased urinary frequency. These effects lasted 4-33 months before decreasing in severity.2
Bladder–sparing trimodal therapy is not for everyone. While cystectomies may not be ideal, but they can still be life saving. There are new advances in bladder treatments and reconstructions occurring regularly, and there are many options to improve a patient’s quality of life after a radical cystectomy.
Keeping an open mind
Have an open discussion with your medical team to come up with a best plan of treatment for your needs. Advances in care mean that therapies are changing all of the time, and while staying educated to new therapies is important, making sure you have an open mind while discussing options with your physician is also very important. Know that your health care team will help you make the best decision for your specific needs and health history. Be sure to talk to them about options for the best quality of life after your surgery. They will be happy that you are engaged and educated about your own health.
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