Treatment Options and Outcomes in Nonmetastatic Muscle Invasive Bladder Cancer

Neoadjuvant chemotherapy followed by radical cystectomy continues to be the standard of care in muscle-invasive bladder cancer, and adjuvant chemotherapy is not supported to date by high-level evidence Lymph node dissection has an established benefit, but the optimal extent is not yet determined Robotic cystectomy is associated with longer operative times, less blood loss, and faster recovery; however, it results in similar complication rates. Enhanced recovery protocols are being adopted and result in faster recovery, less minor complications, and earlier discharge; however, this results in similar long-term and major complication rates. Bladder-preserving strategies are acceptable options for medically unfit patients; however, equivalent results to radical cystectomy are seen in highly-selected patients with strict follow-up and prompt salvage therapy for recurrence or incomplete response. Muscle-invasive bladder cancer (MIBC) represents 25% of newly diagnosed bladder cancer. MIBC is aggressive and requires timely management. The current standard of care is neoadjuvant chemotherapy followed by radical cystectomy, an approach that could result in significant morbidities. Modifications in the chemotherapy regimens, as well as in perioperative care and surgical approach, have resulted in better overall toxicity profile and faster recovery. However, bladder-preservation in carefully selected patients can lead to acceptable oncological outcomes and better quality of life. Optimization of bladder-preservation protocols and proper identification of patients who tolerate and respond to various treatment modalities will significantly impact patient survival in the coming future. Muscle-invasive bladder cancer (MIBC) represents 25% of newly diagnosed bladder cancer. MIBC is aggressive and requires timely management. The current standard of care is neoadjuvant chemotherapy followed by radical cystectomy, an approach that could result in significant morbidities. Modifications in the chemotherapy regimens, as well as in perioperative care and surgical approach, have resulted in better overall toxicity profile and faster recovery. However, bladder-preservation in carefully selected patients can lead to acceptable oncological outcomes and better quality of life. Optimization of bladder-preservation protocols and proper identification of patients who tolerate and respond to various treatment modalities will significantly impact patient survival in the coming future. administered within 3 months after surgery based on adverse pathological findings in the surgical specimen. percentage of people who did not die from cancer. malignant changes limited to mucosal layers without invasion of basement membrane; feature of aggressive disease in bladder cancer. described measure of expression of PD-L1 in tumor cells. percentage of people who did not die from disease, interchangeable with cancer-specific survival in cancer. standardized protocol of perioperative care for a specific surgery. measure of comparison of survival among two interventions. surgical removal of lymph nodes in the landing zone according to established templates. pathological finding that confers higher risk of spread of cancer. percentage of people who continue to live without metastasis of their cancer. invasion of the muscle layer leading to worse outcome; requires immediate aggressive therapy. administered prior to surgery to improve cancer control and survival. cancer that has not invaded the muscularis propria layer and can be in most cases treated with conservative measures. percentage of people still alive at a certain time in the study. programmed cell death protein 1, present on the surface of T cells, that serves to suppress the immune system response to cancer cells. percentage of people who are still alive without progressing locally to higher stage or spreading distantly. radiation to an organ with cancer to treat and control cancer. surgical removal of the bladder to prevent spread of cancer. endoscopic resection of bladder tumor done by accessing the bladder through the urethra; can be diagnostic and therapeutic. consists of maximal resection of bladder tumor followed by simultaneous chemotherapy with radiation therapy.