Efficacy and Safety of Trimodality Bladder Preservation Therapy in Patients with Localized Muscle-Invasive and High-Risk Non-Muscle-Invasive Bladder Cancer

Abstract

Radical cystectomy sustains the gold standard for managing muscle-invasive bladder cancer (MIBC), however It is associated with significant morbidity and considerable deterioration in quality of life. Trimodality therapy (TMT) has arisen as a potential organ-preserving alternative. Aim: To assess the efficacy, bladder preservation rate, and safety profile of TMT in patients with localized MIBC and high-risk NMIBC. Patients and Methods: This prospective study where represents a "selective passive alternative" approach and TMT is offered as the primary option to non-surgical candidates who also meet specific eligibility criteria for bladder preservation .included 151 patients with localized bladder cancer who received maximal TURBT followed by concurrent chemoradiation. Outcomes evaluated included complete response rate, disease-free survival (DFS), overall survival (OS), and treatment-related toxicity. Results: With a median follow-up of 25 months, the 2-year DFS was 65.5%, OS was 85.4%, and the bladder preservation rate was 80%. The treatment demonstrated a favorable safety profile with grade 3-4 toxicity in only 15% of patients. Conclusion: TMT is an effective and safe bladder-preserving alternative to radical cystectomy in carefully selected patients.