Department of Urology.
Department of Radiation Oncology, The Ohio State University, Columbus, Ohio, USA.
Curr Opin Support Palliat Care. 2021 Dec 1;15(4):253-259. doi: 10.1097/SPC.0000000000000579.
To provide a contemporary rationale for bladder preservation as a treatment strategy for muscle-invasive urothelial carcinoma of the bladder. Although the standard of care for this important and serious clinical condition has been radical cystectomy augmented with neoadjuvant systemic chemotherapy, it is associated with substantial morbidity and quality of life (QoL) implications. This article explores the bladder sparing alternatives to radical cystectomy and urinary diversion to assist Urologists, Medical Oncologists, and Palliative Care providers in their informed decision making with patients.
Bladder sparing strategies such as partial cystectomy and trimodality therapy offer long-term cancer outcomes comparable to radical cystectomy in carefully selected patients. Moreover, the toxicity profile in patients, having improved over time, is acceptable, including a low risk of salvage cystectomy.
Bladder preservation therapy offers an alternative to radical cystectomy. In some patients, it can be done with curative intent and in others it can assist with symptom palliation. Bladder preservation can maintain QoL and provide similar oncologic outcomes to radical surgery, although randomized controlled trials have not been performed. Understanding patient selection is a critical step in balancing bladder preservation and cancer survival.
为肌层浸润性膀胱癌的膀胱保留治疗策略提供现代理论基础。虽然新辅助系统化疗联合根治性膀胱切除术是治疗这种重要而严重的临床疾病的标准方案，但该方案与较高的发病率和生活质量（QoL）下降相关。本文探讨了替代根治性膀胱切除术和尿流改道的保留膀胱策略，以帮助泌尿科医生、肿瘤内科医生和姑息治疗医生为患者做出明智的决策。
在精心挑选的患者中，部分膀胱切除术和三联疗法等保留膀胱策略可提供与根治性膀胱切除术相当的长期癌症结局。此外，随着时间的推移，患者的毒性谱得到改善，可接受性提高，包括挽救性膀胱切除术的风险较低。
膀胱保留治疗为根治性膀胱切除术提供了一种替代方案。在某些患者中，可以达到治愈目的，而在另一些患者中，可以辅助缓解症状。保留膀胱可以维持生活质量并提供与根治性手术相似的肿瘤学结果，尽管尚未进行随机对照试验。了解患者选择是平衡膀胱保留和癌症生存的关键步骤。
