Introduction:
When you consider surgery to treat invasive bladder cancer, bladder preservation is the question. So, doctors always consider options to treat tumors and save the organs. It happens in various cancers like breast, anal, prostate, and head and neck cancers. When it comes to invasive bladder cancer, preserving your bladder is a priority, and trimodal therapy is the only option for it. Radical cystectomy is the standard traditional treatment for muscle-invasive bladder cancer (MIBC). Radical cystectomy involves bladder removal due to tumor invasion. So, for such cases, trimodal therapy allows the treatment of cancer without touching the bladder.
What Is Trimodal Therapy?
Trimodal therapy (TMT) is precisely what it sounds like. It is an approach that combines three treatments to manage bladder cancer: surgery, chemotherapy, and radiation therapy. It is an excellent option for people who want to keep their bladder, who cannot undergo major surgery, or who have a small tumor while their bladder is still working well. Instead of removing the entire bladder, TMT takes a more targeted approach.
This includes:
A minor surgery to remove as much of the tumor as possible, chemotherapy to slow down or stop the growth of any remaining cancer cells, and radiation therapy to kill off any cancer that is left behind. Interestingly, research shows that about six percent of people with MIBC improved so much after surgery and chemotherapy that they did not even need radiation! It might not be the right choice for everyone, but doctors carefully examine what is best for the patient. TMT promises a good time ahead with its newer radiation techniques, like intensity-modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). These techniques make treatments harmless, and scientists are looking for better chemotherapy combinations that can treat cancer while causing fewer side effects.
How Does Trimodal Therapy Work?
Trimodal therapy involves three main steps that increase its efficiency in treating invasive bladder cancer. Below is a gist of how it works.
Steps of trimodal therapy:
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The first step in trimodal therapy is the transurethral resection of the bladder tumor (TURBT), which involves removing the tumor. In some cases, a partial cystectomy, removing a portion of the tumor or the bladder, is performed when the tumor is localized.
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After the tumor removal, external beam radiation therapy is used to destroy cancer cells. IMRT and IGRT are some of the latest techniques usually used for focused radiation delivery with minimal damage to other tissues.
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Along with radiation therapy, chemotherapy is also given to increase the cancer-killing effects. A few chemotherapy drugs involve Cisplatin, Fluorouracil, Gemcitabine, and Paclitaxel. A few studies have shown that, in order to achieve good results, these drugs can be combined with other medications, for example, adding Trastuzumab for human epidermal growth factor receptor-2 (HER-2)-positive bladder cancer.
Who Can Get Trimodal Therapy?
Trimodal therapy is not for everyone. The suitable candidates are as follows:
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People who do not want to remove their bladders.
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People who want to undergo surgery, followed by radiation and chemotherapy.
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Small tumors that are restricted to the bladder.
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People with proper bladder function.
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People who do not have any other medical conditions.
Difference Between Trimodal Therapy and Surgery:
Most of the time, the main concern for the doctors is whether to remove the bladder or to save it! There is no middle ground. Trimodal therapy vs. surgery has some unique features as follows:
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For well-suited cases, surgery and trimodal therapy have the same survival rates. After five years of treatment, the survival rates for radical cystectomy are around 70 percent and 65 percent for TMT.
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In TMT, most patients get to save their bladders for a long time. But in surgery, the bladder is obliterated. This may require a urinary diversion using an ostomy bag or neobladder.
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After surgery, many patients come back with complaints like difficulty in controlling the urine, sexual function, and adaptation to lifestyle changes. TMT allows them to have normal bladder function.
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With surgery, there is no risk of cancer recurrence. For TMT, 10 percent of cases need salvage cystectomy if cancer returns. This does not mean that cancer will not happen anywhere else.
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TMT can be considered if the patient is unwilling to undergo bladder removal due to other conditions.
What Are the Side Effects of Trimodal Therapy?
After TMT, people may experience some side effects of the treatment. These side effects can last for a while and can be managed.
They are:
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You may have bladder irritation. It can be due to radiation exposure.
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You may experience an urge to urinate.
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Fatigue.
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Decreased immune function due to chemotherapy.
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Discomfort in the stomach can cause diarrhea.
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Radiation cystitis is the inflammation of the bladder.
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Your bladder may get discolored.
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You can notice blood in the urine.
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Secondary cancer can occur with radiation exposure in rare cases.
How to Manage the Side Effects of Trimodal Therapy?
Managing side effects can seem difficult, but it is not as hard as you think. TMT side effects can be managed with a few changes and medicines. One way is to drink a lot of water to flush out the toxins that help prevent bladder irritation. Eating a low-fiber diet can ease diarrhea. Resting is also important to manage fatigue and tiredness. Antidiarrheals and antiemetics are prescribed for diarrhea, vomiting, or nausea. Let your doctor know about your side effects so they can adjust your treatment.
Follow-up Care After Treatment:
Once TMT is done, you must contact your doctor. Regular care is a must to prevent cancer recurrence. Doctors also perform cystoscopies every three to six months for the first two years to check for any risk of recurrence. Other tests, like urine cytology, CT scans, and MRIs, are also done to look for metastasis (the spreading of cancer) outside the body. Though TMT is successful, there is still a chance of its return. Hence, it should be monitored regularly to avoid further complications.
Latest Advances in Trimodal Therapy
Treatment options for cancer are continually evolving, and trimodal therapy is one of them. Various research studies are studying how to make trimodal therapy more effective by reducing its side effects. Some of its latest advancements are IMRT and IGRT, which are used in radiation therapies to target specific tumors while protecting healthy tissue. Adaptive radiation therapy adjusts treatment in real time based on tumor response. New chemotherapy regimens, such as alternative drug combinations, such as Paclitaxel with Trastuzumab, can improve response rates. Studies have proven that daily radiation dosages work just as well as medicines, making the treatment more feasible. Research is going on to identify genetic markers to anticipate who will respond best to TMT. The subtypes of bladder cancer are known to be more sensitive to TMT, preceding personalized treatment strategies.
Conclusion:
If you have invasive bladder cancer and you do not want to undergo surgery? Think no more; you have trimodal therapy. It is an alternative to radical cystectomy that preserves the bladder and its function. Trimodal therapy has been studied and is known to have good survival rates with improved treatment outcomes. In TMT, your tumor is removed, followed by radiation and chemotherapy. Post-treatment, you will have manageable, mild side effects.
Key Takeaway/A Note from Icliniq
If you are considering trimodal therapy, iCliniq doctors can help you understand how it works, whether it suits you, its side effects, and its long-term effectiveness. Careful patient selection, close monitoring, and adherence to follow-up are needed for good recovery. With all the new developments in therapy, the application of trimodal therapy in the coming days looks vivid.
