Conservative treatments in locally advanced bladder cancer

Abstract

Locally advanced bladder cancer can be cured by cystectomy, radiotherapy or by the combination of both. The standart treatment is radical cystectomy. However, generally within the first two years, distant metastasis occurs in the 40-65% of the patients having surgery performance. Regarding to this situation different clinical research are being carried out for the patients with tumors recurring cystectomy in order to use later. The major problem of radiotherapy is the low local control rate. Although 50% of the patients don't respond completly, 72% of them, who give a complete respond to the treatment, reach high rate of living period. Only with accelerated hyperfractioned external radiotherapy schedule 80% complete respond is achieved. Adding brachytherapy to external radiotherapy 75-80% local control rate and 50-76% rate of 5 years survey are reported. Bladder conservation can be made basing on tumor response of induction therapies made with transurethral resection, chemotherapy and radiotherapy the patients failing to respond. Early cystectomy can be performed to the patients failing to respond. It is found that when 66-80% complete respond is obtained with the combined therapy, 5 years life rate is 45-52% since there is no difference within the 5-10 years survival rate obtained by conservative approach, cystectomy can be put off as long as it is necessary. In this article it is aimed to report the resamblance between the life and local control rate of the patients responding conservative treatment and the surgical group, besides the clinical trials related to the protection against physical and psychological trauma caused by cystectomy performed as soon as it is diagnosed.