Koiso K, Shipley W, Keuppens F, Baert L, Hall R, Hudson M A, Khoury S, Kubota Y, Kubota Y, van Poppel H
University of Tsukuba Institute of Clinical Medicine, Department of Urology, Ibaraki, Japan.
Int J Urol. 1995 Jun;2 Suppl 2:49-57. doi: 10.1111/j.1442-2042.1995.tb00479.x.
The recommended treatment for medically fit patients with muscle-invading bladder cancer is usually radical cystectomy. However, transurethral resection of the tumor, partial cystectomy, irradiation and systemic chemotherapy are each effective in some patients. These latter treatments allow bladder preservation and cure as an alternative to radical cystectomy although when used unselectively the survival rates are inferior to those of radical cystectomy. The updated results of conservative surgery, radiation therapy and systemic chemotherapy as monotherapy, as well as strategies of combined modality treatment were reviewed. Based on this review many areas of consensus were reached which include: 1. The primary goal of any treatment for a patient with muscle-invading bladder cancer is survival; bladder preservation in the interest of quality of life is a secondary objective. 2. Only a small proportion of carefully selected patients may be cured by transurethral surgery alone, or by partial cystectomy alone. 3. Radiation therapy is currently the standard bladder-preserving therapy against which all other bladder-preserving methods must be compared. 4. Systemic chemotherapy as monotherapy is inadequate and cannot be recommended. 5. The addition of cisplatin-containing systemic chemotherapy to radiation therapy or conservative surgery appears to improve local control. While no multi-modality therapeutic regimen has yet been shown to be clearly optimal with regard to local efficacy and minimizing toxicity, monotherapy for bladder preservation is probably not desirable as a routine approach. 6. Deferring the patient from immediate cystectomy does not appear to compromise survival, nor does the addition of primary systemic chemotherapy appear to significantly increase the morbidity of cystectomy or radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)
对于身体状况适合的肌层浸润性膀胱癌患者，推荐的治疗方法通常是根治性膀胱切除术。然而，经尿道肿瘤切除术、部分膀胱切除术、放疗和全身化疗在某些患者中均有效。尽管这些后几种治疗方法在未进行选择的情况下使用时生存率低于根治性膀胱切除术，但它们能使患者保留膀胱并实现治愈，可作为根治性膀胱切除术的替代方案。本文回顾了保守手术、放射治疗和全身化疗作为单一疗法的最新结果，以及综合治疗策略。基于该综述达成了许多共识领域，其中包括：1. 对肌层浸润性膀胱癌患者进行任何治疗的主要目标都是生存；为了生活质量而保留膀胱是次要目标。2. 只有一小部分经过精心挑选的患者可能仅通过经尿道手术或仅通过部分膀胱切除术治愈。3. 放射治疗目前是标准的保留膀胱疗法，所有其他保留膀胱的方法都必须与之比较。4. 全身化疗作为单一疗法是不够的，不能被推荐。5. 在放射治疗或保守手术中加入含顺铂的全身化疗似乎能改善局部控制。虽然尚未有任何多模式治疗方案在局部疗效和最小化毒性方面被证明是明显最优的，但保留膀胱的单一疗法作为常规方法可能并不可取。6. 推迟患者立即进行膀胱切除术似乎不会影响生存，加入一线全身化疗似乎也不会显著增加膀胱切除术或放疗的发病率。（摘要截断于250字）
