What are the bladder-sparing approaches for treating stage 2 (T2) bladder cancer?

From the Guidelines

Bladder-sparing approaches, such as trimodality therapy combining maximal transurethral resection of the bladder tumor (TURBT) followed by concurrent chemoradiation therapy, are viable options for treating stage 2 (T2) bladder cancer, as recommended by the NCCN guidelines 1. The primary goal of these approaches is to preserve bladder function while achieving optimal oncologic outcomes.

• The most common chemotherapy regimens used in conjunction with radiation therapy include cisplatin alone or combinations like cisplatin plus 5-FU, cisplatin plus paclitaxel, and 5-FU plus mitomycin C, with doublet chemotherapy generally preferred 1.
• Patients with smaller, unifocal tumors without extensive carcinoma in situ, hydronephrosis, or deep muscle invasion are typically considered suitable candidates for bladder-sparing approaches.
• After treatment, patients require rigorous surveillance with cystoscopy every 3-4 months initially, along with urine cytology and imaging studies, to monitor for recurrence or persistence of disease.
• The overall tumor status should be reassessed 2 to 3 months after treatment, and if no tumor is evident, the patient should be observed, while if tumor is observed, further treatment options such as chemotherapy, concurrent chemoradiation, palliative TURBT, or best supportive care may be considered 1.
• It is essential to note that salvage cystectomy may still be necessary if the cancer persists or recurs, and patients must be thoroughly informed about the potential risks and benefits of bladder-sparing approaches.
• The NCCN guidelines emphasize the importance of careful patient selection and multidisciplinary evaluation in determining the most appropriate treatment approach for individual patients with stage 2 bladder cancer 1.

From the FDA Drug Label

Advanced Bladder Cancer Cisplatin Injection is indicated as a single agent for patients with transitional cell bladder cancer which is no longer amenable to local treatments, such as surgery and/or radiotherapy. The answer to bladder-sparing approaches for treating stage 2 (T2) bladder cancer is not directly addressed in the provided drug label. The FDA drug label does not answer the question.

From the Research

Bladder-Sparing Approaches for Stage 2 (T2) Bladder Cancer

• The standard treatment for muscle-invasive bladder cancer, including stage 2 (T2), is radical cystectomy, but bladder-sparing approaches are being explored as alternatives 2, 3, 4.
• Trimodal therapy (TMT), which consists of maximal transurethral resection of the bladder tumor followed by concurrent radiosensitizing chemotherapy and radiotherapy, is a well-studied bladder-sparing approach for select patients with nonmetastatic muscle-invasive bladder cancer 4.
• TMT has shown promising results, with 5-year overall survival rates of 50% to 70% in well-selected patients, but it is not suitable for all patients, and careful selection is necessary 4.
• Other bladder-sparing approaches, such as partial cystectomy, radiation monotherapy, and radical transurethral resection, have also been described, but TMT is considered the most oncologically favorable regimen 4.
• The use of intravesical bacillus Calmette-Guérin (BCG) has been shown to be effective in reducing recurrence and progression in patients with high-risk superficial bladder cancer, and it may also be considered as a bladder-sparing approach for select patients with stage 2 (T2) bladder cancer 5, 6.
• Bladder-sparing approaches require close cooperation between different clinical specialists and careful follow-up, and they may not be suitable for all patients, particularly those with advanced disease or significant comorbidities 2, 3.