Medical Oncology Branch, National Cancer Institute, Bethesda, MD 20014, USA.
Urol Oncol. 2012 Nov-Dec;30(6):772-80. doi: 10.1016/j.urolonc.2012.01.012.
At the 11th annual meeting of the Society of Urologic Oncology, an expert panel was convened to discuss the practical use of perioperative chemotherapy for muscle-invasive bladder cancer. The discussion was structured as a case-based debate among the panelists. The topics included: neoadjuvant chemotherapy with a focus on T2 disease, pros and cons, survival data, tolerability of cisplatin-based therapy, can we avoid radical cystectomy in complete responders, limitations and alternatives to cisplatin-based therapy, management of 'suboptimal' chemotherapy, residual disease after neoadjuvant chemotherapy, adjuvant chemotherapy, and key aspects of radical cystectomy and lymph-node dissection in multimodal therapy. The presentations were derived from published literature. The panelists agreed that patients with muscle-invasive bladder cancer should be managed with a multidisciplinary team, including urologist and medical oncologist. Cisplatin-based neoadjuvant chemotherapy has demonstrated improved survival and should be incorporated into the management of all eligible patients with muscle-invasive bladder cancer. However, in some centers, neoadjuvant chemotherapy is reserved for patients with >T2 disease or high-risk features. There are no data for the administration of non-cisplatin-based neoadjuvant chemotherapy, such as carboplatin-combinations. Cisplatin-ineligible patients should proceed directly to surgical extirpation with adjuvant cisplatin-based chemotherapy considered based on pathologic findings. However, the data for adjuvant chemotherapy is less compelling. As our refinement of the selection process continues, we may be able to better identify subsets of patients who may be spared chemotherapy, but much work remains to be done in this arena. The current standard for muscle-invasive bladder cancer patients is cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy and pelvic lymph-node dissection.
在第 11 届泌尿肿瘤学会年会上，一个专家小组讨论了围手术期化疗在肌层浸润性膀胱癌中的实际应用。讨论采用基于案例的小组辩论形式进行。讨论的主题包括：新辅助化疗（重点是 T2 疾病）、优缺点、生存数据、顺铂为基础的治疗耐受性、能否避免在完全缓解的患者中进行根治性膀胱切除术、顺铂为基础的治疗的局限性和替代方法、“次优”化疗的管理、新辅助化疗后残留疾病、辅助化疗以及多模态治疗中根治性膀胱切除术和淋巴结清扫的关键方面。演讲内容源自已发表的文献。小组成员一致认为，肌层浸润性膀胱癌患者应由多学科团队管理，包括泌尿科医生和肿瘤内科医生。顺铂为基础的新辅助化疗已显示出可改善生存，应纳入所有符合条件的肌层浸润性膀胱癌患者的治疗中。然而，在一些中心，新辅助化疗仅保留用于>T2 疾病或高危特征的患者。尚无非顺铂为基础的新辅助化疗（如卡铂联合化疗）的数据。不能使用顺铂的患者应直接进行手术切除，根据病理结果考虑使用顺铂为基础的辅助化疗。然而，辅助化疗的数据说服力不足。随着我们对选择过程的不断完善，我们可能能够更好地识别出可能免于化疗的患者亚组，但在这一领域仍有许多工作要做。目前肌层浸润性膀胱癌患者的标准治疗方法是顺铂为基础的新辅助化疗，随后进行根治性膀胱切除术和盆腔淋巴结清扫术。
