Radical Cystectomy is the best choice for most patients with muscle-invasive bladder cancer? Opinion: No

Vol. 43 (2): 188-191, March – April, 2017

doi: 10.1590/S1677-5538.IBJU.2017.02.04


DIFFERENCE OF OPINION

Timur Mitin 1
1 Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon

Keywords: Urinary Bladder Neoplasms; Cystectomy; Chemoradiotherapy, Adjuvant; Neoadjuvant Therapy


Progress is a hallmark of human civilization. Over the past centuries, it became easier, faster and safer to travel from point A to point B, and the choices of transportation are now numerous, making it at times challenging for travelers to make their selection and forcing them to buy guidebooks, research travel websites and sometimes even contact the travel agents. Perhaps sailing was once the only way of crossing the ocean, but with advent of aviation it is no longer the case. Similarly, upfront radical surgeries were once patients’ only hope for cure – radical mastectomy for patients with breast cancer, amputation for patients with extremity sarcoma, laryngectomy for patients with laryngeal cancer, radical prostatectomy for patients with prostate cancer, abdominoperineal resection for patients with anal carcinoma. However, over the past 40 years the field of oncology has embraced organ preservation, often, but not always, through randomized clinical trials showing equivalent outcomes with smaller surgeries and adjuvant radiation therapy, or replacement of upfront surgery with definitive chemoradiation therapy, reserving organ extirpation for salvage in case of local recurrences. The management of muscle-invasive bladder cancer (MIBC) is no different (1).

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