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Trimodality Therapy - Bladder Cancer

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Embracing Trimodal Therapy as a Viable Alternative to Radical Cystectomy

Leslie Ballas | May 16, 2024

For years, the standard treatment for muscle-invasive bladder cancer (MIBC) was radical cystectomy (RC), preceded by neoadjuvant cisplatin-based chemotherapy (NAC), if tolerable. Currently, the National Comprehensive Cancer Center (NCCN) has two category 1 recommendations for patients with cT2-T4aN0 MIBC: NAC followed by cystectomy, and trimodal therapy (TMT).1

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Leslie BallasLeslie Ballas, MD, Dr. Ballas is a Radiation Oncologist at Cedars Sinai Medical Center in Los Angeles, California who specializes in the treatment of genitourinary cancers. Dr. Ballas is both a clinician and clinical investigator studying bladder preservation with Trimodality Therapy (TMT), the use of adjuvant radiotherapy (RT) following cystectomy, and radiotherapy effects on bladder cancer patients.
Videos
Clinical Conversations by Experts
Physician-Scientist Commentaries
Peer-reviewed Abstract Supplemental Commentaries
Written by Bishoy M. Faltas
Englander Institute for Precision Medicine, Weill Cornell Medicine
Radical cystectomy and Trimodality therapy, which combines transurethral resection of the bladder tumor (TURBT) and concurrent chemoradiation, are effective treatments for muscle-invasive bladder cancer (MIBC). A recent study investigated the outcomes of patients with MIBC who were eligible for both treatment options.
Written by Alexandre Zlotta MD & Jason Efstathiou MD
Radical cystectomy is widely used in muscle-invasive bladder cancer management, but even with improvements in surgical technique, it remains a major operation with significant morbidity, perioperative mortality, and quality of life-altering changes. Bladder preservation has been evaluated as a treatment for muscle-invasive bladder cancer since the 1980s
Conference Coverage
Conference Highlights Written by Physician-Scientist
Presented by Gopakumar Iyer, MD
The 2024 American Society for Radiation Oncology (ASTRO) annual meeting held in Washington D.C., was host to the session Presidential Symposium: Innovations in Genitourinary Cancers: Session II - Bladder Preservation - A Modern Choice for Patients. Dr. Gopakumar Iyer discussed how to Integrate Novel Therapeutics with trimodal therapy (TMT).
Presented by Leslie Ballas, MD, FASTRO
The 2024 ASTRO annual meeting was host to the session Presidential Symposium: Innovations in Genitourinary Cancers: Session II - Bladder Preservation - A Modern Choice for Patients. Dr. Leslie Ballas opened this session with a talk titled: Bladder Preservation - A Modern Choice for Patients.
Presented by Kent Mouw, MD, PhD
The 2024 IBCN annual meeting included a session on advancements in circulating biomarkers, featuring a presentation by Dr. Kent Mouw discussing the correlation of ctDNA dynamics with clinical response in muscle-invasive bladder cancer patients undergoing trimodality therapy.
Presented by Jason A. Efstathiou, MD, DPhil
(UroToday.com) The 2022 ASTRO annual meeting featured a session on bladder and kidney preservation, including a presentation by Dr. Jason Efstathiou discussing a multi-institutional matched comparison of radical cystectomy to trimodality therapy for muscle invasive bladder cancer. 
Presented by Alexandre Zlotta
(UroToday.com) Prior randomized controlled trials comparing bladder preservation to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) closed due to lack of accrual. None are foreseen in the near future. Thus, we aimed to compare trimodality therapy (TMT, maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) to radical cystectomy (RC) in matched cohorts of patients with MIBC.
Presented by Sophia C. Kamran, MD
(UroToday.com) On the second day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2022, Dr. Sophia Kamran presented in a session highlighting novel therapies in bladder cancer and their toxicities, discussing the role of bladder-sparing trimodality therapy with a focus on toxicity and functional outcomes.
Presented by Alexandre R. Zlotta, MD, PhD
(UroToday.com) On the second day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2022 focusing on urothelial carcinoma, Dr. Zlotta presented a comparison of radical cystectomy and trimodality therapy in the treatment of patients with muscle-invasive bladder cancer (MIBC) in a session focused on a Potpourri of Hot Topics in Urothelial Carcinoma.
Presented by Richard Lee, MD, MBA, Urologist
(UroToday.com) In anticipation of the 2021 American Urological Association (AUA) Annual Meeting which is being held, in a delayed fashion, in September, the AUA hosted a “May Kick-Off Weekend” which highlighted a variety of important topics in both benign urology and urologic oncology. Saturday afternoon, Adam Feldman led a course entitled “Trimodality Therapy (TMT) for Management of Muscle Invasive Bladder Cancer” along with faculty Richard Lee and Jason Efstathiou.
Presented by Adam Feldman, MD, MPH, Urologist
(UroToday.com) In anticipation of the 2021 American Urological Association Annual Meeting which is being held, in a delayed fashion, in September, the AUA hosted a “May Kick-Off Weekend” which highlighted a variety of important topics in both benign urology and urologic oncology. Saturday afternoon, Adam Feldman led a course entitled “Trimodality Therapy for Management of Muscle Invasive Bladder Cancer” along with faculty Richard Lee and Jason Efstathiou.
Presented by Adam Feldman, MD, MPH, Urologist
(UroToday.com) In anticipation of the 2021 American Urological Association (AUA) Annual Meeting which is being held, in a delayed fashion, in September, the AUA hosted a “May Kick-Off Weekend” which highlighted a variety of important topics in both benign urology and urologic oncology. Saturday afternoon, Adam Feldman led a course entitled “Trimodality Therapy (TMT) for Management of Muscle Invasive Bladder Cancer” along with faculty Richard Lee and Jason Efstathiou.
Presented by Jason Efstathiou, MD, DPhil
(UroToday.com) In anticipation of the 2021 American Urological Association (AUA) Annual Meeting which is being held, in a delayed fashion, in September, the AUA hosted a “May Kick-Off Weekend” which highlighted a variety of important topics in both benign urology and urologic oncology. Saturday afternoon, Adam Feldman led a course entitled “Trimodality Therapy (TMT) for Management of Muscle Invasive Bladder Cancer” along with faculty Richard Lee and Jason Efstathiou.
Presented by Jason Efstathiou, MD, DPhil
(UroToday.com) In anticipation of the 2021 American Urological Association (AUA) Annual Meeting which is being held, in a delayed fashion, in September, the AUA hosted a “May Kick-Off Weekend” which highlighted a variety of important topics in both benign urology and urologic oncology. Saturday afternoon, Adam Feldman led a course entitled “Trimodality Therapy (TMT) for Management of Muscle Invasive Bladder Cancer” along with faculty Richard Lee and Jason Efstathiou.