Six patients (26%) developed a new primary or recurrence of UCB in the bladder; 3 of these patients were treated with salvage cystectomy.
UCB or SCCB, salvage cystectomy should be considered for local recurrences.
25] There are other reports on recurrences/secondary bladder cancers occurring 24 to 50 months after treatment, with survival data up to 8 years with salvage cystectomy.
27] While the reported 5-year OS rates of 48% to 63% for bladder preservation therapies consisting of transurethral resection of bladder cancer (TURBT) followed by chemoradiation may be comparable to the cystectomy group, it is noteworthy that with longer follow-up, 35% to 45% of these patients end up requiring salvage cystectomy
(due to suboptimal local disease control), which is certainly technically more challenging, with reported complications as high as 58.
In contrast, bladder preservation with salvage cystectomy in Europe has had a longer history--in some centres, it is the recommended approach.
The modern approach to bladder preservation involves careful cystoscopic evaluation, transurethral resection of the bladder to minimize the extent of residual disease, concurrent chemoradiotherapy followed by regular cystoscopic evaluation, and salvage cystectomy for recurrence.
8] In this protocol, patients completed the full course of chemoradiotherapy and underwent transurethral resection of bladder cancer (TURBT) restaging at 6 weeks to 8 weeks and salvage cystectomy for recurrence.
Salvage cystectomy results in 40% to 50% survival rates at 5 years and local regional control rates of 60%.