Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Curr Opin Urol. 2013 Sep;23(5):429-34. doi: 10.1097/MOU.0b013e328363de04.
The management of nonmuscle invasive bladder cancer (NMIBC) recurrent after bacillus Calmette-Guérin therapy is complex and further complicated by high numbers of patients who are not candidates for cystectomy. This article reviews data supporting the use of chemoradiation in NMIBC and discusses emerging biomarkers of treatment response.
Radiotherapy, especially when combined with chemotherapy, has shown great promise for treating bladder cancer. Recent studies have identified that many patients with bladder cancer do not receive potentially curative therapies. Many such patients are elderly or infirm and represent an unmet need for curative therapeutic alternatives to radical cystectomy. Although radiotherapy alone does not appear superior to intravesical therapy in NMIBC, at least one series with long-term follow-up has shown excellent results in patients treated with radiation and concurrent chemotherapy. A clinical trial investigating the role for chemoradiation in T1 disease that has recurred is underway. Biomarkers able to predict radiotherapy response may allow for personalized therapy in the near future.
Chemoradiation is an emerging treatment option for selected patients with NMIBC. Prospective validation of currently identified biomarkers is needed along with further research to identify which patients may benefit the most from such therapy.
卡介苗（BCG）治疗后复发的非肌肉浸润性膀胱癌（NMIBC）的治疗管理较为复杂，并且由于大量患者不适合进行膀胱切除术，使得治疗管理变得更加复杂。本文综述了支持在 NMIBC 中使用放化疗的数据，并讨论了新兴的治疗反应生物标志物。
放射治疗，特别是与化疗联合应用时，已显示出对治疗膀胱癌的巨大潜力。最近的研究发现，许多膀胱癌患者未接受潜在的治愈性治疗。许多此类患者年龄较大或身体虚弱，对根治性膀胱切除术的替代治疗方法存在未满足的治愈需求。虽然单纯放疗在 NMIBC 中似乎并不优于膀胱内治疗，但至少有一项具有长期随访的研究表明，在接受放疗和同期化疗的患者中，效果非常好。一项正在进行的关于复发 T1 疾病中放化疗作用的临床试验正在进行中。能够预测放疗反应的生物标志物可能在不久的将来允许进行个性化治疗。
放化疗是一种治疗 NMIBC 患者的新兴治疗选择。需要对目前已确定的生物标志物进行前瞻性验证，同时还需要进一步研究以确定哪些患者最可能从这种治疗中获益。
