Bladder Preservation for Muscle-Invasive Bladder Cancer With Variant Histology

dc.contributor.authorBrocklehurst, A.
dc.contributor.authorVarughese, M.
dc.contributor.authorBirtle, A.
dc.description.abstractA growing body of evidence has shown bladder-preservation with chemo-radiotherapy achieves comparable survival to Radical Cystectomy (5-year OS 50%-70%) and superior quality of life outcomes for patients with muscle-invasive urothelial carcinoma of the bladder (UC). However, up to 55% of patients harbor variant histology and in this review we aim to clarify the role of bladder-preservation for this group. We first draw the distinction between urothelial carcinoma with divergent differentiation (UCDD) and non-urothelial carcinoma (NUC). UCDD is common, increasing in prevalence, and whilst each subtype may have its own characteristics current evidence suggests comparable outcomes with radical cystectomy and bladder-preservation. Non-urothelial carcinoma is a collection of distinct pathologies each deserving of its own management strategy. However, these tumors are rare, and evidence is generated from retrospective studies with significant inherent bias. Small cell carcinoma of the bladder has good evidence for bladder-preservation; however, other pathologies such as Squamous Cell Carcinoma and Adenocarcinoma are not well supported. We recommend careful multidisciplinary appraisal of the evidence for each subtype and honest patient discussion about the limited evidence before reaching management decisions. As we look to the future molecular-profiling may help better characterize these tumors and aid in treatment selection.
dc.description.admin-notePublished version, accepted version (12 month embargo)
dc.description.noteSupports Open Access
dc.identifier.citationSemin Radiat Oncol. 2023 Jan;33(1):62-69. doi: 10.1016/j.semradonc.2022.10.008.
dc.identifier.journalSeminars in radiation oncology
dc.rightsCopyright © 2022. Published by Elsevier Inc.
dc.subjectUrinary Bladder/pathology
dc.subjectRetrospective Studies
dc.subjectQuality of Life
dc.subject*Urinary Bladder Neoplasms
dc.subject*Carcinoma, Transitional Cell/therapy/pathology
dc.subjectTreatment Outcome
dc.titleBladder Preservation for Muscle-Invasive Bladder Cancer With Variant Histology
dc.typeJournal Article Review