Villà Freixa S
Servicio de Oncología Radioterápica, Institut Català d'Oncologia, Hospitalet, Barcelona, España.
Arch Esp Urol. 1999 Jul-Aug;52(6):614-24.
To review the state-of-the-art of treatment of infiltrating cancer of the urinary bladder with combination neoadjuvant or concomitant chemotherapy and full dose radiotherapy for organ preservation.
Series from different hospitals, cooperative study groups and the experience of the Catalan Institute of Oncology in conservative treatment of bladder cancer with combined radio and neoadjuvant or concomitant chemotherapy are analyzed.
Stage, presence of hydronephrosis, associated carcinoma in situ and response to treatment are some of the decisive prognostic factors. Wide transurethral resection was also found to be of prognostic importance. Cisplatin is currently the most effective cytostatic agent. Patient selection improves the mortality rate and percentage of patients that are disease free and with a functioning bladder, especially when concomitant chemo and radiotherapy are utilized. Late bladder toxicity does not increase and the utilization of some cytostatic regimens is limited by acute toxicity.
Patient selection for conservative treatment aimed at bladder preservation increases the percentage of bladders preserved. The possibility of extending the indications for this therapeutic approach should be investigated in controlled trials.
回顾采用新辅助或同步化疗联合全剂量放疗以保留器官治疗浸润性膀胱癌的最新进展。
分析来自不同医院、合作研究组的系列研究以及加泰罗尼亚肿瘤研究所采用放疗联合新辅助或同步化疗保守治疗膀胱癌的经验。
分期、肾积水的存在、相关原位癌以及对治疗的反应是一些决定性的预后因素。广泛经尿道切除术也被发现具有预后意义。顺铂是目前最有效的细胞抑制剂。患者选择可提高无病且膀胱功能正常患者的死亡率和比例，尤其是在采用同步化疗和放疗时。晚期膀胱毒性并未增加，一些细胞抑制方案的应用受到急性毒性的限制。
选择适合保留膀胱的保守治疗的患者可增加保留膀胱的比例。应在对照试验中研究扩大这种治疗方法适应证的可能性。
