Instead of a cystectomy, you may have trimodal therapy as the main treatment for muscle-invasive bladder cancer. Trimodal therapy may be used if a person is unable to have surgery to remove the bladder or would prefer to keep their bladder. It is most suited for people whose bladder is working well and who have smaller cancers that haven’t spread.
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What trimodal therapy involves
Trimodal therapy involves:
- surgery to remove the tumour from the bladder (TURBT)
- after surgery, radiation therapy combined with chemotherapy (chemoradiation) to destroy remaining cancer cells. People who are not fit enough for chemotherapy will have radiation therapy on its own.
Studies have shown that trimodal therapy has similar outcomes to radical cystectomy for certain small cancers. However, there is a chance the cancer may come back in the bladder and cystectomy may still be required. Talk to your medical team to discuss whether trimodal therapy may be an option for you.
Having trimodal therapy
If you have trimodal therapy, chemotherapy or other medicines are given to make the cancer cells more sensitive to radiation, which can increase the success of the treatment. You will usually have radiation therapy as daily treatments, Monday to Friday, over 4–7 weeks as an outpatient.
There are different options for receiving chemotherapy. Some people will have chemotherapy once a week a few hours before or after a radiation therapy session. Other people take a tablet or have an infusion over several days.
During and after chemoradiation, you may experience side effects from both the chemotherapy and the radiation therapy. Talk to your treatment team about ways to manage the side effects of chemoradiation.
The bladder is not removed in trimodal therapy, so you can still urinate in the usual way. You will need to have regular cystoscopies after treatment to check that the cancer has not come back.
Treatment for bladder cancer can be complex and you may need to travel to a specialist centre for treatment. Call Cancer Council 13 11 20 to ask about patient travel assistance that may be available.
→ READ MORE: Advanced bladder cancer
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Key resource
Download a PDF booklet on this topic.
More resources
Dr Prassannah Satasivam, Urologist and Robotic Surgeon, Epworth Hospitals and Cabrini Hospitals, VIC; Donna Clifford, Urology Nurse Practitioner, Royal Adelaide Hospital, SA; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Renee Finnigan, Radiation Oncologist, Gold Coast University Hospital, QLD; Lisa Hann, 13 11 20 Consultant, Cancer Council SA; Dr Andrew Hirschhorn, Director of Allied Health and MQ Health Academy, MQ Health, Macquarie University, NSW; Anne Marie Lyons, Stomal Therapy Nurse, Concord Hospital and NSW Stoma Limited, NSW; John McDonald, Consumer; Prof Manish Patel, Urological Cancer and Robotic Surgeon, Westmead Hospital, Macquarie University Hospital, and The University of Sydney, NSW; Dr Jason Paterdis, Urological Surgeon, Brisbane Urology Clinic, QLD; Graeme Sissing, Consumer; Prof Martin Stockler, Medical Oncologist, The University of Sydney, Concord Cancer Centre, and Chris O’Brien Lifehouse RPA, NSW.
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