Abstract
While systemic treatment in combination with surgery has very successfully been implemented into therapeutic practice based on studies demonstrating a clinical benefit, the utilization rate of radiotherapy as an alternative to cystectomy in highly selected patients varies in different countries. Bladder preservation therapy is particularly suitable for patients unable or unwilling to undergo radical surgery.
In order to obtain good therapeutic results, it is essential to perform radical transurethral resection of the bladder tumour (TURBT) and administer concomitant chemotherapy that improves 5-year survival by as much as 13 %. Under these circumstances, it is possible to achieve preservation of a functional bladder in up to 80 % of long-term surviving patients, with severe late toxicity of grade 3 and higher (according to the RTOG scale) not exceeding 10 %.
Conversely, when a conservative approach is indicated in patients with tumours not allowing TURBT, locally advanced disease (T3-4), and hydronephrosis, or when cisplatin is contraindicated, only a palliative effect of the treatment may rather be expected.