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Daniel A. Hamstra, MD, PhD, FASTRO, FASCO, explores advances in bladder cancer therapy, focusing on trimodality bladder preservation. In this 21-minute presentation, he compares the North American approach, which requires strict criteria for bladder preservation, including thorough TURBT and an absence of extensive CIS, to a more inclusive UK approach, which tolerates certain conditions such as CIS and hydronephrosis and utilizes non-platinum-based chemotherapy.

Hamstra shares a significant UK phase III trial that illustrates the effectiveness of adding chemotherapy to radiation, enhancing local control and survival, and reducing the need for cystectomy. A multi-institutional study comparing this approach with radical cystectomy indicates comparable metastasis-free and overall survival rates, suggesting trimodality therapy as a viable alternative to surgery.

Hamstra notes that neoadjuvant chemotherapy is emerging as beneficial in bladder preservation, with data supporting its utility across different cancers when combined with radiation. For node-positive bladder cancer, combined chemoradiotherapy (chemoRT) appears as effective as surgery in appropriately selected patients.

Newer immunotherapies and non-platinum regimens continue to expand options, while evidence supports chemoRT as an alternative to radical surgery, especially for patients prioritizing quality of life and organ preservation.