Reduced salvage cystectomy
rate and improved survival were observed with complete transuretheral resection of bladder tumor prior to bladder preservation18.
It is the lack of confidence on TMT that 25%-35% between 70-80 years and 35-55% over 80 years do not receive potentially curative therapy.1,9,10 The major concerns with the modality (TMT) include post therapy functional status of bladder and the need for second major procedure as Salvage cystectomy. However the available data reveals that 75% of TMT patients maintain intact and functioning bladder.
Likewise only 21% undergo salvage cystectomy without survival compromise.1,11 Yes, we do not have randomized comparable data between RC and TMT but other series with long-term data suggest comparable outcome with TMT (60-80% Complete Response rates) and RC in terms of Overall and disease - specific survival rates even with salvage cystectomy if necessary.12 Although the data is particularly lacking in Asian population, one of the series reported from dedicated Urology Tertiary referral centre by Tunio et al from Karachi, Pakistan shared comparable outcome with TMT for sizable sample of 111 patients with a median Follow up of 3 years.
No patients with PC subsequently underwent salvage cystectomy
in our data.
RADIATION THERAPY: Results of a clinical trial comparing neo-adjuvant radiotherapy before cystectomy to definitive radiotherapy followed by salvage cystectomy
for progressive disease with advanced UC were published by Bloom et al.
T3 bladder cancer-the case for salvage cystectomy
. Br J Urol 1980; 52:506-10.
Six patients (26%) developed a new primary or recurrence of UCB in the bladder; 3 of these patients were treated with salvage cystectomy.[sup.87]
UCB or SCCB, salvage cystectomy should be considered for local recurrences.
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.
In addition, 60% of patients remained free of any noninvasive or invasive recurrence and 84% of patients with recurrent noninvasive recurrences are maintained in remission with transurethral resection and intravesical therapy.[sup.13,14] Invasive recurrences generally require salvage cystectomy. Salvage cystectomy results in 40% to 50% survival rates at 5 years and local regional control rates of 60%.[sup.12] Interestingly, the 5-year metastatic rate in the early cystectomy patients (who did not complete the full course of chemoradiotherapy) and the later salvage cystectomy patient were similar, at 50%.[sup.12]
The treatment options boil down to radical cystectomy (with neoadjuvant chemotherapy or adjuvant chemotherapy for selected patients) or TURBT and neoadjuvant chemotherapy followed by concurrent chemoradiotherapy and salvage cystectomy.