Bladder Sparing Options for Muscle-Invasive Bladder Cancer - Beyond the Abstract
For selected patients, especially those unfit for or choosing to avoid RC approaches like trimodal therapy—combining maximal transurethral resection of the bladder tumor, radiotherapy, and concurrent chemotherapy—offer oncological outcomes comparable to RC. The integration of immunotherapy into bladder-sparing protocols has opened new avenues, with combinations of immune checkpoint inhibitors (ICI) and chemoradiation, showing promising early results in enhancing treatment efficacy.
As research continues, a focus on biomarker-based approaches (e.g., liquid biopsy), new combinations of systemic therapy agents (e.g., with antibody-drug conjugates), novel drug delivery methods, and advanced imaging techniques (e.g., mpMRI, PET/CT) will further refine bladder-sparing strategies. These developments, coupled with improved response assessment protocols, could expand the role of bladder preservation in treating MIBC, offering personalized, patient-centered care. However, continued efforts are essential to allow careful patient selection, standardize definitions of clinical response, and ensure rigorous follow-up for bladder preservation candidates.
The future of MIBC treatment will likely see a growing role for bladder-sparing approaches, providing patients with more treatment options tailored to their needs and preferences.
Written by: Ekaterina Laukhtina, MD, Medical University of Vienna, Vienna, Austria
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