Kanady K E, Shipley W U, Zietman A L, Kaufman D S, Althausen A F, Heney N M
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Semin Surg Oncol. 1997 Sep-Oct;13(5):359-64. doi: 10.1002/(sici)1098-2388(199709/10)13:5<359::aid-ssu10>3.0.co;2-i.
Combined modality therapy with the goal of effecting cure and achieving organ preservation has become the standard oncological approach in many malignancies. Although radical cystectomy has been considered the standard treatment for invasive carcinoma of the bladder, equivalent results have been achieved using combined modality treatment in selected patients, particularly those with T2 and T3a disease without obstructed ureters. Effective combined modality treatment consists of three treatment modalities: (1) transurethral resection of the bladder tumor (TURBT), followed by concurrent (2) chemotherapy, and (3) radiation. Following induction therapy, histologic response is evaluated by cystoscopy and biopsy. Clinical complete responders continue with concurrent chemotherapy and irradiation. Those patients not achieving a clinical complete response are advised to undergo cystectomy. Individually the local monotherapies of radiation, TURBT, or systemic chemotherapy each achieve a local control rate of 20% to 40%. When they are combined, complete response rates of 70-80% are achieved and 85% of these will remain free of invasive recurrence in the bladder. Bladder preservation trials using combined modality treatment approaches with selection for organ conservation by response to initial treatment report an overall 5-year survival rate of approximately 50%, and they have achieved a 40% to 45% 5-year survival rate with the bladder intact. Modern multi-modality bladder preservation approaches offer survival rates similar to radical cystectomy, for patients of similar clinical stage and age, and an improved quality of life by allowing a majority of patients to retain their own fully functional bladder. Bladder conservation therapy may be offered to selected patients with bladder cancer as one alternative to radical cystectomy, and its use should be by experienced multi-modality teams of urologic oncologists.
以治愈和保留器官为目标的综合治疗已成为许多恶性肿瘤的标准肿瘤治疗方法。尽管根治性膀胱切除术一直被认为是浸润性膀胱癌的标准治疗方法，但在部分患者中，尤其是输尿管未梗阻的T2和T3a期疾病患者，采用综合治疗也取得了相当的效果。有效的综合治疗包括三种治疗方式：（1）经尿道膀胱肿瘤切除术（TURBT），随后同时进行（2）化疗和（3）放疗。诱导治疗后，通过膀胱镜检查和活检评估组织学反应。临床完全缓解者继续进行同步化疗和放疗。那些未达到临床完全缓解的患者建议接受膀胱切除术。单独来看，放疗、TURBT或全身化疗等局部单一疗法的局部控制率均为20%至40%。当它们联合使用时，完全缓解率可达70%-80%，其中85%的患者膀胱将无浸润性复发。采用综合治疗方法并根据初始治疗反应选择保留器官的膀胱保留试验报告的总体5年生存率约为50%，并且在膀胱完整的情况下实现了40%至45%的5年生存率。对于临床分期和年龄相似的患者，现代多模式膀胱保留方法提供的生存率与根治性膀胱切除术相似，并且通过让大多数患者保留自己功能完全正常的膀胱，提高了生活质量。膀胱保留治疗可作为根治性膀胱切除术的一种替代方案提供给部分膀胱癌患者，并且应由经验丰富的泌尿外科肿瘤多模式团队使用。
