The article Dan was referring to is about using
TUR only for muscle invasive blc, and not using any chemo+radiation or just radiation or just chemo...it was a small investigation into the feasibility of using tumor resection alone. It is a scary article that highlights the shortcomings of present diagnostics.
Dan sent this to the email group, so I'm copying his summary here:
tinyurl.com/3ahapo
Organ Preservation For Muscle Invasive Bladder Cancer
By Transurethral Resection
... evaluated 327 patients with muscle-invasive
bladder cancer who were treated in at M.D. Anderson
from 1997 to 2002.
... Repeat bladder tumor resection was repeated in
all patients. If the patient had no residual
tumor..., ...bladder preservation was offered.
...Patients who opted for bladder preservation by
transurethral resection alone did not receive
intravesical therapy!!!
... 35 (11%) were eligible for bladder preservation
... 27 elected to pursue this approach
... 8 opted for immediate cystectomy (... 4 had no
residual tumor and one died from metastatic disease)
... Of the 27 patients who did have bladder
preservation, 15 experienced subsequent tumor
recurrence, 8 of whom underwent radical cystectomy.
Of the 8 that had a delayed cystectomy 4 had node
positive disease and 5 had extravesical disease...
They conclude "Bladder preservation using
transurethral resection is feasible in selected
patients, only 11% of the eligible population.
Unfortunately, despite close surveillance 30% needed
a cystectomy and of these 8 patients 50% had node
positive disease and 62% had extravesical disease.
This highlights that our current surveillance
programs are inadequate to identify recurrent bladder
cancer at a curable stage."
