Trimodal Therapy in the Treatment of Muscle-Invasive Bladder Cancer

Abstract

This review examines the evolution, clinical efficacy, and future directions of trimodal therapy (TMT) as a bladder-preserving treatment option for muscle-invasive bladder cancer. A nonsystematic literature search was conducted on PubMed in October 2024 using the following keywords: “muscle invasive bladder cancer,” “bladder preservation,” “trimodal therapy,” “chemoradiotherapy,” and “radiation therapy.” Papers published between 2000 and 2024 were included, and original articles, reviews, and editorials written in English were selected. Relevant studies were organized and cited in the analysis. TMT, which consists of transurethral resection of the bladder tumor, chemotherapy, and radiotherapy, demonstrated comparable oncologic outcomes to radical cystectomy (RC) in terms of 5-year overall survival (36%–74%) and cancer-specific survival (50%–82%). Long-term data from multiple studies indicate that TMT can preserve bladder function while maintaining acceptable survival rates. The recent integration of immune checkpoint inhibitors with TMT shows promise, further improving tumor control and expanding the eligible patient population. However, standardized protocols and long-term follow-up data are still lacking. TMT serves as an effective alternative to RC in selected patients, offering similar oncologic outcomes while preserving quality of life. Further research is needed to establish standardized protocols and to refine patient selection criteria to optimize treatment outcomes.

Keywords

• muscle-invasive bladder cancer
• chemoradiation
• trimodal therapy
• bladder-sparing therapy
• bladder preservation therapy