The standard treatment for muscle-infiltrating bladder cancer is radical total cystectomy + urinary diversion because of the significantly increased chance of metastasis. However, this procedure is very invasive, has many complications and seriously affects the patient’s quality of life (urination, sexual function, socialization, etc.). Therefore, many prestigious medical centers in China and abroad are offering bladder-preserving comprehensive treatment in order to treat muscle-invasive bladder cancer while preserving normal bladder function.
Ms. Zhang, a 32-year-old woman, was diagnosed with bladder cancer in an outside hospital due to hematuria and underwent transurethral resection of bladder tumor (TURBT). The preferred option was radical cystectomy with combined urinary diversion, and ileal catheterization (abdominal wall stoma with urinary bag) was recommended because of the poor urinary control effect of the new bladder in women compared with men. The patient and family refused total cystectomy and urinary diversion and switched to a combination of bladder preservation. Radiation therapy to the bladder was given at 38 Gy, followed by 2 courses of arterial chemotherapy (gemcitabine + cisplatin). After completion of adjuvant radiotherapy, bladder electrosurgery was performed to evaluate the treatment effect and no residual tumor was seen. After regular review of cystoscopy, recurrence occurred after 9 months, TURBT was performed again, pathology suggested infiltrating submucosa, high grade (T1G3), tumor stage decreased compared to the previous, piroplatin bladder irrigation was given, regular review. The tumor was then infused into the bladder for 1 year and reviewed regularly.
Because of the combination therapy (radiation therapy + chemotherapy) Ms. Zhang was effectively treated for muscle invasive bladder cancer while preserving normal bladder function. It is worth noting that even if the combination therapy can effectively treat bladder cancer, it is important to review closely after surgery to treat the recurrent tumor in time and remove it at an early stage to ensure the treatment effect. Meanwhile, our more than 10 years of experience shows that there are still 10-20% of patients who are not sensitive to radiotherapy, and these patients still need to undergo total cystectomy + urinary diversion eventually because of tumor progression.