Experts appraise benefits of cystectomy, chemo-radiation

Radical treatment of bladder cancer remains a controversial subject and experts yesterday carefully weighted the benefits of surgical treatment vis-à-vis the advantages offered by chemo or radiotherapy, particularly in less fit or elderly patients.

Chaired by Profs. Manfred Wirth (DE) and James Catto (UK) who both noted the rising incidence of bladder cancer particularly among elderly men, the panel composed of Profs. Nicholas James (UK), Arnulf Stenzl (DE), Karim Fizazi (FR) and Peter Wiklund (SE) evaluated the prospects and respective benefits of cystectomy and neoadjuvant or adjuvant chemotherapy as bladder preserving strategies.

“We live in an era where we question the practice of cystectomy,” noted Catto as he introduced the lecture by James who spoke on the outcomes of the BC2001 trial. James pointed out that contrary to the widespread view, chemo-radiation can offer some benefits to certain types of patients.

“Bladder preserving therapy with chemo-radiotherapy gives good and long-term bladder function,” he said in his summary remarks. “Synchronous chemotherapy can be given after neoadjuvant treatment.”

James also noted that radio-sensitising agents substantially improve local control and ended his talk by posing the question: “The question to consider is whether it is time to re-evaluate the role of bladder preservation?”

In response, Stenzl discussed the level of safety that can be gained with radical cystectomy and underscored that there had been advances in surgical procedures that lead to better outcomes. He mentioned cystectomy procedures with and without sparing autonomous nerves, and also outlined the pros and cons in using robotics and laparoscopy, adding that robot-assisted cystectomy has the same results as open surgery.

“We have seen an improvement in technique, capacity and quality of life,” Stenzl said referring to cystectomy.

A case discussion followed with the panel examining various strategies that aim to provide optimal treatment for muscle invasive bladder cancer. They highlighted careful patient selection, quality of life issues and providing the patient with comprehensive information. After the case discussion, Profs. Marko Babjuk (CZ) and Stenzl spoke on the EAU Guidelines, demonstrating a practical approach in the management of patients with urothelial cancer. In their lectures they highlighted the place or role the Guidelines can have in the physician’s decision-making.