Treatment Approaches to MIBC Pts | ||
| TREATMENT | PT SELECTION | CLINICAL OUTCOMES |
|---|---|---|
| Bladder-sparing chemoradiation | No CIS, no hydronephrosis, maximal TURBT required | 65% cure, 55% bladder intact, highly dependent on pt selection |
| Bladder-sparing partial cystectomy | Solitary tumors in dome of bladder are ideal | Variable, highly dependent on pt selection |
| Cystectomy | Any MIBC pt | 50% cure with surgery alone, highly dependent on pathologic stage |
| Neoadjuvant cisplatin-based chemotherapy | Cisplatin-eligible MIBC pts | 5-10% improvement in overall survival compared to cystectomy alone |
| Adjuvant cisplatin-based chemotherapy | Cisplatin-eligible high-risk postcystectomy MIBC pts (pT3-4, N+) | Similar improvement as neoadjuvant treatment, data less robust, many pts not suitable for adjuvant treatment |