March 10, 2021
The decision depends on the extent of the tumor
- Treatment for oligometastatic bladder cancer hasn’t been well-defined
- Radical cystectomy can reduce disease burden, but it comes with risks
- Surgery may be worthwhile for patients with limited metastasis
Treatment for metastatic bladder cancer is well established. The majority of patients receive systemic therapies such as chemotherapy or immunotherapy. But for patients in the transitional oligometastatic bladder cancer state, the consideration may also include radical cystectomy.
“The oligometastatic setting for bladder cancer hasn’t really been well-defined,” Dr. Roger Li, urologic oncologist at the Moffitt Cancer Center in Tampa, FL, tells SurvivorNet Connect.
Radical cystectomy can minimize disease burden, but it also carries risks ranging from bleeding to infection. In some patients, those risks may not be worth the minimal survival advantage surgery offers. Researchers have been trying to determine in which patients radical cystectomy might offer the greatest benefit.
“During fellowship, I actually led a study from MD Anderson looking at performing radical cystectomy on these patients,” Dr. Li says. He and his colleagues found that patients with a low burden of metastasis whose cancer was confined to a single organ derived a survival benefit from surgery followed by chemotherapy. However, he discovered that patients with more than one metastatic lesion did not get the same benefit.
Even though many other factors come into play, including a patient’s comorbidities and frailty, because of the risks involved in the procedure, “We have to be very discreet in using it as a treatment modality, especially in a setting where the benefit is very marginal,” he says.