Rödel Claus
Department of Radiation Therapy, University of Erlangen, Erlangen, Germany.
Strahlenther Onkol. 2004 Nov;180(11):701-9. doi: 10.1007/s00066-004-9195-y.
Standard treatment for muscle-invasive bladder cancer is radical cystectomy. Combined-modality treatment (CMT), including transurethral resection (TURBT), radiation therapy (RT) and systemic chemotherapy, has been shown to produce survival rates comparable to those of radical cystectomy. With these programs, cystectomy has been reserved for patients with incomplete response or local relapse after trimodality treatment.
This review summarizes series of radical RT with different fractionation schedules and focuses on CMT for muscle-invasive bladder cancer. Current protocols of the bladder-sparing approach will be discussed and the background of future developments, including incorporation of promising new chemotherapeutic agents as well as the role of predictive and prognostic factors in selecting patients for the respective treatment alternatives, will be given.
There is moderate evidence that hyperfractionated and accelerated regimens are superior to conventional RT at least in situations where no concomitant chemotherapy is applied. Several phase II studies and one phase III study indicate that concomitant radiochemotherapy is superior to RT alone. In modern series of CMT, 5-year survival rates in the range of 50-60% have been published, and about three quarters of the surviving patients maintained their own bladder. Recent data suggest that incorporation of newer chemotherapeutic agents, particularly gemcitabine and taxanes, in CMT protocols is feasible and promising. Clinical criteria helpful in determining patients for bladder preservation include such variables as early tumor stage, unifocal tumor, a visibly and microscopically complete TURBT, and absence of ureteral obstruction.
CMT for bladder cancer is a reasonable treatment option for patients who are deemed medically unfit for cystectomy and for those seeking an alternative to radical cystectomy.
肌层浸润性膀胱癌的标准治疗方法是根治性膀胱切除术。综合治疗（CMT），包括经尿道膀胱肿瘤切除术（TURBT）、放射治疗（RT）和全身化疗，已被证明其生存率与根治性膀胱切除术相当。采用这些方案时，膀胱切除术仅用于接受三联疗法后反应不完全或局部复发的患者。
本综述总结了不同分割方案的根治性放疗系列研究，并重点关注肌层浸润性膀胱癌的综合治疗。将讨论当前膀胱保留方法的方案，并介绍未来发展的背景，包括引入有前景的新型化疗药物以及预测和预后因素在选择相应治疗方案患者中的作用。
有中等证据表明，至少在未应用同步化疗的情况下，超分割和加速方案优于传统放疗。几项II期研究和一项III期研究表明，同步放化疗优于单纯放疗。在现代综合治疗系列研究中，已发表的5年生存率在50%至60%之间，约四分之三的存活患者保留了自己的膀胱。最新数据表明，在综合治疗方案中引入更新的化疗药物，特别是吉西他滨和紫杉烷，是可行且有前景的。有助于确定适合膀胱保留患者的临床标准包括早期肿瘤分期、单灶性肿瘤、肉眼和显微镜下TURBT完整以及无输尿管梗阻等变量。
对于那些被认为不适合进行膀胱切除术的患者以及那些寻求根治性膀胱切除术替代方案的患者，膀胱癌的综合治疗是一种合理的治疗选择。
