Tselis N, Prott F J, Ott O, Weiss C, Rödel C
Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland.
, Wiesbaden, Deutschland.
Urologe A. 2018 Jun;57(6):679-685. doi: 10.1007/s00120-018-0628-0.
The standard treatment for muscle-invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy. Primary organ-preservation by means of multimodal therapy, however, can be a viable alternative to radical surgery.
The concept and results of multimodal therapy, consisting of initial transurethral resection of the bladder tumor (TUR-B), followed by simultaneous radiochemotherapy (RCT), are presented.
Evaluation of retrospective cohorts and prospective therapy optimization studies on organ-preservation treatment regimens. Comparative meta-analyses comparing cystectomy with multimodal treatment are presented.
Complete TUR-B, including bladder mapping and tumor biopsy, should precede simultaneous RCT. Radiosensitization should be cisplatin-based or consist of a combination of 5‑fluorouracil and mitomycin C. Complete response rates after TUR-B plus RCT are generated in 60-90% of patients along with 5‑year survival rates of 40-75% and preservation of the bladder in approximately 80% of surviving patients.
Multimodal therapy by means of TUR-B followed by simultaneous RCT is a viable alternative to radical cystectomy for patients with muscle-invasive urinary bladder carcinoma. Patients with early tumors (cT2/3N0) are particularly suitable in whom initial TUR-B leads to complete tumor resection (R0).
肌层浸润性膀胱癌的标准治疗方法是根治性膀胱切除术加盆腔淋巴结清扫术。然而，通过多模式治疗进行原发性器官保留可以成为根治性手术的可行替代方案。
介绍多模式治疗的概念和结果，该治疗包括初始经尿道膀胱肿瘤切除术（TUR-B），随后进行同步放化疗（RCT）。
对器官保留治疗方案的回顾性队列和前瞻性治疗优化研究进行评估。呈现了将膀胱切除术与多模式治疗进行比较的荟萃分析。
在同步RCT之前应先进行完整的TUR-B，包括膀胱绘图和肿瘤活检。放射增敏应以顺铂为基础或由5-氟尿嘧啶和丝裂霉素C联合组成。TUR-B加RCT后的完全缓解率在60%至90%的患者中产生，5年生存率为40%至75%，约80%的存活患者膀胱得以保留。
对于肌层浸润性膀胱癌患者，先进行TUR-B然后进行同步RCT的多模式治疗是根治性膀胱切除术的可行替代方案。早期肿瘤（cT2/3N0）患者尤其适合，初始TUR-B可实现肿瘤完全切除（R0）。
