Radboud University Nijmegen, Department of Urology , PO Box 9101, Nijmegen, 6500 HB , The Netherlands.
Expert Opin Biol Ther. 2013 Oct;13(10):1371-85. doi: 10.1517/14712598.2013.824421. Epub 2013 Aug 20.
Transurethral resection of the bladder tumour (TURBT) is still the standard initial treatment for non-muscle invasive bladder cancer (NMIBC). However, even after a radical resection, recurrence (30 - 80%) and progression (1 - 45%) are commonly seen. Intravesical therapy provides direct contact of the agent with the bladder mucosa and clearly has improved the outcome, especially in high-risk disease.
The role of a good initial TURBT is emphasized. Risk assessment tools are discussed. Different intravesical therapies are enumerated according to the latest literature, with the emphasis on Bacillus Calmette-Guérin (BCG), including the discussion on the optimal dose and schedule. New developments are mentioned.
A radical TURBT is essential for good prognosis. For optimal visualisation of tumours, fluorescence techniques should be used with low threshold, especially in case of suspicion of carcinoma in situ (CIS). Increased completeness of the resection will lead to less persisting disease and less need for adjuvant treatment. A re-TURBT should be done when in doubt of radical resection (judged by the pathologist or the surgeon). Risk assessment is essential, but the available tools are outdated. A single post-operative instillation (SPI) with chemotherapy is only indicated in low-risk disease. BCG is the treatment of choice for high-grade disease. BCG should be given as maintenance. Awareness of deterioration of the prognosis after progression is of great importance. In BCG failures, cystectomy should be strongly advised. Chemotherapy in combination with hyperthermia seems to be a new promising treatment.
经尿道膀胱肿瘤切除术（TURBT）仍然是非肌肉浸润性膀胱癌（NMIBC）的标准初始治疗方法。然而，即使进行了根治性切除，复发（30-80%）和进展（1-45%）仍然很常见。膀胱内治疗提供了药物与膀胱黏膜的直接接触，明显改善了治疗效果，特别是在高危疾病中。
强调了良好初始 TURBT 的作用。讨论了风险评估工具。根据最新文献列举了不同的膀胱内治疗方法，重点介绍了卡介苗（BCG），包括讨论最佳剂量和方案。提到了新的发展。
彻底的 TURBT 对于良好的预后至关重要。为了更好地观察肿瘤，应使用低阈值的荧光技术，特别是在怀疑原位癌（CIS）时。增加切除的完整性将减少持续存在的疾病和对辅助治疗的需求。在怀疑根治性切除不彻底时（由病理学家或外科医生判断），应进行再次 TURBT。风险评估至关重要，但现有的工具已经过时。单次术后化疗灌注（SPI）仅适用于低危疾病。对于高级别疾病，BCG 是治疗的首选。BCG 应作为维持治疗。了解进展后预后恶化的重要性。在 BCG 失败的情况下，强烈建议行膀胱切除术。化疗联合热疗似乎是一种新的有前途的治疗方法。
