Bladder Preservation with Radiation: An Effective Alternative to Radical Cystectomy

Summary Radical treatment of localized disease T2-T4a, N0 muscle invasive bladder cancer (MIBC) is either radical cystectomy with pelvic lymph node dissection or Radiotherapy within bladder preservation approach. The bladder preservation approach involves complete transurethral resection (TUR) followed by neoadjuvant chemotherapy and concurrent radiotherapy (RT) with a radiosensitizer. The better morbidity profile favors RT, both approaches have comparable survival outcomes. The UK attempted to compare surgery with radiation in a randomized study (SPARE), was closed early due to poor recruitment, it was a multicenter feasibility pilot to determine the standard of care in locally advanced bladder cancer was possible.