Bladder Cancer

Abstract

Bladder cancer is the 9th most common cancer diagnosis worldwide. There are more than 330,000 new cases each year and more than 130,000 deaths per year. Although radical cystectomy has been considered as standard for localised muscle-invasive bladder cancer, there is rapidly growing evidence from numerous phase-II-studies that concurrent radiochemotherapy yields survival rates identical to surgical series but with the chance of bladder preservation in 70% to 80% of long-term survivors. Patients treated in organ-sparing protocols should initially undergo a complete transurethral resection of the bladder tumour (TUR-BT), followed by chemoradiotherapy. Major prognostic factor of the overall remission are the completeness of the TUR-BT prior to radiotherapy and the use of chemotherapy. The overall survival of patients lies in the range of about 50% after 5 years which is nearly identical to cystectomy series. Major prognostic factors for overall survival such as age or T-category etc. are reported. The acute toxicity of radiotherapy is moderate. Late toxicity of organ-preserving treatment protocols is low and compares favourably to series with radical cystectomy. A small number of prognostic factors are well established for patients undergoing radiotherapy or radiochemotherapy for bladder cancer (especially age, T-category and completeness of TUR). Currently, there are few nomograms and prognostic models available; all of them include different clinical prognostic factors. New molecular factors have so far not been sufficiently investigated. Nomograms for toxicity (which is low) are not available.