The Latest Efforts to Preserve the Bladder

Chemotherapy alone may not be enough

• Therapeutic strategies today aim to preserve the bladder with neoadjuvant treatment or radiation
• Chemotherapy alone may not be enough to prevent bladder tumors from eventually recurring
• According to Dr. Roger Li, radiation should be reserved only for patients with solitary masses at low risk for spreading

In solid tumors affecting organs, efforts have been made to preserve the organ while still eradicating the cancer. The same is true for bladder cancer. Radical cystectomy with pelvic lymph node dissection is a highly morbid procedure, which is often performed in patients who are already elderly and frail.

“There have been efforts to see if we can preserve the bladder, either after neoadjuvant treatments or with radiation,” Dr. Roger Li, urologic oncologist at the Moffitt Cancer Center in Tampa, FL, tells SurvivorNet Connect.

The problem is that, although chemotherapy produces an initial response, the tumor will eventually recur and may develop resistance to the chemotherapy. “You can’t continuously give additional chemotherapy because it’s very toxic,” Dr. Li says. And given that additional mutations can evolve over time and give rise to more tumors in the future, “chemotherapy alone followed by observation may be dangerous in this particular population.”

He adds that our current staging procedures, cystoscopy and transurethral resection (TUR), aren’t adequate to detect clinically significant residual cancer. “And so, up to 30% of the patients who have a clinically complete response after chemotherapy, if they were to go on to radical cystectomy, will be found to have muscle invasive disease,” Dr. Li says.

Until we develop better staging tools, he believes it’s dangerous to rely on chemotherapy as a sole therapeutic modality. The same is true of radiation, which he feels should be reserved only for patients with solitary bladder masses that are superficially invading the muscle wall, who have no other high-risk feature that might indicate cancer spread. “The data is there showing that, for well-selected patients, radiation can be used effectively,” he says.