Editing CUA: Muscle-invasive Bladder Cancer (2019) (section)

=== Trimodal therapy (TMT) ===
* '''Involves radical TURBT + external beam radiotherapy + concomitant systemic chemotherapy'''
** With TMT, maximal/radical TURBT should be performed to clear all visible tumour prior to initiation of chemoradiation
** '''Different chemotherapy regimens have been used, but most evidence exists for cisplatin and mitomycin C plus 5-FU'''
* '''Can be offered to select patients wishing to preserve their bladder, those unfit for cystectomy or those refusing cystectomy'''
** In carefully selected patients, TMT offered in a multidisciplinary bladder cancer clinic yielded moderate-term disease-specific survival rates rivalling that of RC (73% for RC, 77% for TMT).
** Kulkarni, Girish S., et al. "Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic." Journal of Clinical Oncology 35.20 (2017): 2299-2305. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/28410011</nowiki>
* '''Ideal characteristics for TMT are as follows (6):'''
*# '''Unifocal'''
*# '''Small (<5cm) tumour'''
*# '''No CIS'''
*# '''No hydronephrosis'''
*# '''Good bladder function'''
*# '''Patient motivated for bladder preservation'''
** '''Only ≈20-25% of surgically fit patients meet the criteria for TMT bladder preservation'''
** '''[Random bladder biopsies (plus prostatic urethral biopsy) should be performed prior to TMT to rule out occult disease;''' not explicitly stated in guidelines but similar concept to rule out occult CIS as with partial cystectomy?]