Black Peter C, Efstathiou Jason
Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Urol Oncol. 2021 Apr;39(4):209-212. doi: 10.1016/j.urolonc.2020.09.001. Epub 2020 Sep 30.
There is an underutilization of potentially curative treatments for patients with muscle-invasive bladder cancer. Contemporary trimodality bladder-preservation therapy - which includes a maximally safe transurethral resection of the bladder tumor followed by concurrent chemoradiation and close cystoscopic surveillance with salvage cystectomy reserved for invasive tumor recurrence - can help fulfill this unmet need. Over the past few decades, cumulative published data from prospective clinical trials and large institutional series have established trimodality therapy (TMT) for select patients as a safe and effective alternative to upfront cystectomy. Indeed, TMT is now supported as an accepted option for muscle-invasive bladder cancer patients by numerous clinical guidelines. Following TMT, the vast majority of long-term survivors maintain their native bladders, which tend to function well with relatively low rates of long-term toxicity and good long-term quality of life. There is the potential to further improve outcomes by optimizing systemic therapy integration and by validating predictive biomarkers for improved patient and treatment selection. TMT offers a unique opportunity for urologic surgeons, radiation oncologists and medical oncologists to work hand-in-hand in a multidisciplinary effort to deliver such therapy optimally, to support its research, to promote informed decision-making and ultimately to preserve the autonomy of patients with bladder cancer. The third annual meeting of the Johns Hopkins Greenberg Bladder Cancer Institute/American Urological Association Translational Research Collaboration allowed bladder cancer experts to meet and advance this mission.
对于肌层浸润性膀胱癌患者，潜在的治愈性治疗方法未得到充分利用。当代三联保膀胱治疗——包括最大程度安全的经尿道膀胱肿瘤切除术，随后进行同步放化疗，并通过膀胱镜密切监测，对于侵袭性肿瘤复发则保留挽救性膀胱切除术——有助于满足这一未被满足的需求。在过去几十年中，前瞻性临床试验和大型机构系列研究积累的已发表数据表明，对于特定患者，三联疗法（TMT）是 upfront 膀胱切除术的一种安全有效的替代方案。事实上，现在众多临床指南都支持 TMT 作为肌层浸润性膀胱癌患者的一种可接受选择。接受 TMT 治疗后，绝大多数长期存活者保留了他们的天然膀胱，这些膀胱往往功能良好，长期毒性发生率相对较低，长期生活质量良好。通过优化全身治疗整合以及验证预测性生物标志物以改善患者选择和治疗选择，有可能进一步改善治疗结果。TMT 为泌尿外科医生、放射肿瘤学家和医学肿瘤学家提供了一个独特的机会，使他们能够携手合作，通过多学科努力来最佳地提供这种治疗，支持其研究，促进明智的决策制定，并最终维护膀胱癌患者的自主性。约翰霍普金斯格林伯格膀胱癌研究所/美国泌尿外科学会转化研究合作组织的第三届年会让膀胱癌专家得以相聚并推进这一使命。
