对于肌层浸润性膀胱癌，历史上的黄金标准治疗方法是根治性膀胱切除术。然而，通过三联疗法（包括膀胱肿瘤最大经尿道切除后的化疗和放疗）实现器官保留的概念已被证实是完全切除膀胱的可行治疗替代方案。尽管缺乏直接头对头的随机比较TMT与根治性膀胱切除术，但放射治疗肿瘤学组（RTOG）/ NRG多年来一直引领着将放射治疗作为膀胱保留的一部分，前瞻性数据表明，前瞻性数据表明长期临床结果与切除膀胱的系列相似，特别是在当代治疗下。我们总结了这些试验，并讨论了膀胱保留在几十年间的演变，最终在我们目前的TMT协议中达到了顶峰。我们进一步讨论了未来肌层浸润性膀胱癌器官保留治疗的发展方向，包括放疗技术的持续改进、新型治疗方法的融合和个性化治疗的实施，以最大程度地优化膀胱癌患者的益处。版权所有©2022 Elsevier Inc.。保留所有权利。

For muscle-invasive bladder cancer, the historical, gold standard treatment was radical cystectomy. However, the notion of organ preservation using trimodality therapy (TMT, consisting of maximal transurethral resection of bladder tumor followed by chemoradiation) has been established as a viable treatment alternative to complete removal of the bladder. Despite the lack of direct head-to-head randomized comparisons of TMT to radical cystectomy, the Radiation Therapy Oncology Group (RTOG)/NRG has spearheaded the use of radiation therapy as part of bladder preservation for years, with prospective data demonstrating similar long-term clinical outcomes to cystectomy series, particularly with contemporary treatment. We summarize these trials and discuss the evolution of bladder preservation throughout the decades, culminating in our current TMT protocols. We further discuss the future of organ-preservation therapy in MIBC, with continued improvement in radiation techniques, incorporation of novel therapies, and personalization of treatment to optimize benefit for bladder cancer patients.Copyright © 2022 Elsevier Inc. All rights reserved.