Regional Therapy of Bladder Tumors

Bladder cancer is a relatively frequent urologic malignancy, with 70% of cases initially diagnosed as non-muscle-invasive bladder cancer. Regional therapy involves maximal transurethral resection of bladder tumor (TURBT) followed by treatments such as intravesical chemotherapy, intravesical immunotherapy, extirpative surgery, or chemoradiation. Pathologic staging and risk stratification are used to help guide further therapy. For intermediate- and high-risk patients, intravesical Bacillus Calmette-Guerin (BCG) vaccine remains the most well-studied and successful treatment modality. Other intravesical therapies play a role such as mitomycin, epirubicin, and gemcitabine. In cases of BCG failure, second-line therapies are highlighted such as valrubicin and combination therapies such as gemcitabine and docetaxel. Failure of second-line therapies and early recurrence may require radical cystectomy. For muscle-invasive bladder cancer, neoadjuvant, cisplatin-based chemotherapy followed by radical cystectomy remains the gold standard. A minority of patients with muscle-invasive bladder cancer are candidates for bladder preservation with trimodal therapy of TURBT and chemoradiation.