Abstract：
OBJECTIVE: The aim of this review is to summarize the current evidence and future perspectives of bladder-sparing treatment for MIBC.
METHODS: A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords \"bladder cancer\", \"bladder-sparing\", \"trimodal therapy\", \"chemoradiation\", \"biomarkers\", \"immunotherapy\", \"neoadjuvant chemotherapy\", \"radiotherapy\".
RESULTS: Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to preserve their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly oriented toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes. Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation.
CONCLUSIONS: Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.
METHODS: A non-systematic literature search in Medline/Pubmed was performed in October 2023 with the following keywords \"bladder cancer\", \"bladder-sparing\", \"trimodal therapy\", \"chemoradiation\", \"biomarkers\", \"immunotherapy\", \"neoadjuvant chemotherapy\", \"radiotherapy\".
RESULTS: Urology guidelines recommend radical cystectomy as the standard curative treatment for muscle-invasive urothelial bladder cancer, reserving radiotherapy for patients who are unfit or who want to preserve their bladder. Given the morbidity and mortality of cystectomy and its impact on quality of life and bladder function, modern oncologic therapies are increasingly oriented toward organ preservation and maximizing functional outcomes while maintaining treatment efficacy. Trimodal therapy, which incorporates maximal transurethral resection followed by radiotherapy with concurrent radiosensitizing chemotherapy, is an effective regimen for bladder function preservation in well-selected patients. Despite the absence of comparative data from randomized trials, the two approaches seem to provide comparable oncologic outcomes. Studies are evaluating the expansion of eligibility criteria for trimodal therapy, the optimization of radiotherapy and immunotherapy delivery to further improve outcomes, and the validation of biomarkers to guide bladder preservation.
CONCLUSIONS: Trimodal therapy has shown acceptable outcomes for bladder preservation; therefore, it provides a valid treatment option in well-selected patients.
摘要：
目的：这篇综述的目的是总结MIBC保留膀胱治疗的当前证据和未来前景。
方法：于2023年10月在Medline/Pubmed中进行了非系统文献检索，关键字为\“膀胱癌\”，“保留膀胱”，“三联疗法”，“化学放射”，“生物标志物”，“免疫疗法”，“新辅助化疗”，放射治疗\“。
结果：泌尿外科指南推荐根治性膀胱切除术作为肌层浸润性尿路上皮膀胱癌的标准治疗方法，为不适合或想要维持膀胱的患者保留放疗。鉴于膀胱切除术的发病率和死亡率及其对生活质量和膀胱功能的影响，现代肿瘤治疗越来越倾向于器官保存和最大化功能结果，同时保持治疗效果。三模疗法,其中包括最大程度的经尿道切除术，然后进行放疗和同步放射增敏化疗，是在精心挑选的患者中保留膀胱功能的有效方案。尽管没有随机试验的比较数据，这两种方法似乎提供了可比的肿瘤结局.研究正在评估三峰疗法的资格标准的扩展，优化放疗和免疫治疗以进一步改善预后，和生物标志物的验证，以指导膀胱保存。
结论：三峰疗法对膀胱保存治疗显示出可接受的结果；因此，它为精心挑选的患者提供了有效的治疗选择。
方法：于2023年10月在Medline/Pubmed中进行了非系统文献检索，关键字为\“膀胱癌\”，“保留膀胱”，“三联疗法”，“化学放射”，“生物标志物”，“免疫疗法”，“新辅助化疗”，放射治疗\“。
结果：泌尿外科指南推荐根治性膀胱切除术作为肌层浸润性尿路上皮膀胱癌的标准治疗方法，为不适合或想要维持膀胱的患者保留放疗。鉴于膀胱切除术的发病率和死亡率及其对生活质量和膀胱功能的影响，现代肿瘤治疗越来越倾向于器官保存和最大化功能结果，同时保持治疗效果。三模疗法,其中包括最大程度的经尿道切除术，然后进行放疗和同步放射增敏化疗，是在精心挑选的患者中保留膀胱功能的有效方案。尽管没有随机试验的比较数据，这两种方法似乎提供了可比的肿瘤结局.研究正在评估三峰疗法的资格标准的扩展，优化放疗和免疫治疗以进一步改善预后，和生物标志物的验证，以指导膀胱保存。
结论：三峰疗法对膀胱保存治疗显示出可接受的结果；因此，它为精心挑选的患者提供了有效的治疗选择。
