Thariat J, Caullery M, Ginot A, Hannoun-Lévi J-M, Barrière J, Buthaud X, Marcié S, Bondiau P-Y, Housset M, Lagrange J-L, Amiel J, Gérard J-P
Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06189 Nice cedex 2, France.
Prog Urol. 2009 Feb;19(2):85-93. doi: 10.1016/j.purol.2008.11.002. Epub 2008 Dec 16.
Radical cystectomy is the treatment of choice for nonmetastatic, muscle-infiltrating bladder cancer. However, bladder-sparing approaches can be discussed in carefully selected patients. Bladder-preservation protocols aim to guaranty local control and survival with a functional bladder and a good quality of life. Such strategies include combinations of transurethral resection and radiochemotherapy, partial cystectomy and brachytherapy, radiotherapy-cystotomy and electrontherapy. Strict selection criteria and close follow-up are mandatory. New irradiation techniques hold the promise to improve local control by selectively boosting the dose to the tumor while better sparing the organs at risk. Such advances include the use of multimodal imaging, image-guided radiotherapy, concomitant boost with conformal irradiation+/-intensity modulated radiation therapy. Brachytherapy, either high-dose or pulsed-rate, is a promising technique for selected cases. Highly-conformal irradiation with tumor tracking using the Cyberknifetrade mark technology may also provide opportunities to boost the tumor while reducing toxicities. Specific innovative irradiation techniques are discussed.
根治性膀胱切除术是治疗非转移性、肌肉浸润性膀胱癌的首选方法。然而，对于经过精心挑选的患者，可以讨论保留膀胱的方法。膀胱保留方案旨在确保局部控制和生存，同时保留功能正常的膀胱并提高生活质量。这些策略包括经尿道切除术与放化疗、部分膀胱切除术与近距离放疗、放疗膀胱切开术与电子治疗的联合应用。严格的选择标准和密切的随访是必不可少的。新的放疗技术有望通过选择性地增加肿瘤剂量同时更好地保护危险器官来提高局部控制效果。这些进展包括多模态成像、图像引导放疗、适形放疗联合增强照射+/-调强放疗的应用。高剂量或脉冲剂量率的近距离放疗是某些特定病例的一种有前景的技术。使用赛博刀商标技术进行肿瘤追踪的高适形放疗也可能在提高肿瘤剂量的同时降低毒性方面提供机会。文中还讨论了特定的创新放疗技术。
