020IC - Trimodality Therapy for Management of Muscle Invasive Bladder Cancer

This course is a comprehensive review of tri-modal therapy for muscularis propria invasive urothelial carcinoma of the bladder with a multidisciplinary faculty including urology, radiation oncology and medical oncology. We will review results from prospective randomized trials and large institutional experiences in tri-modality bladder sparing therapy. The course will focus on the urologist’s critical role in patient selection for this approach vs. radical cystectomy. We will discuss the technique and importance of aggressive transurethral resection and repeat resection prior to proceeding to chemotherapy and radiation, as well as the continued role of the urologist in repeat cystoscopic assessments of tumor response and ongoing surveillance of the bladder. We will review the coordinated multidisciplinary approach for bladder preservation, including radiation fields, role of concurrent chemotherapy and need for early salvage cystectomy when indicated, as well as management of non-muscle invasive recurrences. We will review potential toxicities and quality of life associated with bladder sparing therapy versus cystectomy and will address emerging topics such as novel biomarkers and the potential role of combining radiation with immunotherapy and other targeted therapies.