Brinkley W M, Torti F M
Department of Hematology and Oncology, Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27157, USA.
Semin Surg Oncol. 1997 Sep-Oct;13(5):365-75. doi: 10.1002/(sici)1098-2388(199709/10)13:5<365::aid-ssu11>3.0.co;2-m.
Although the incidence of bladder cancer has increased in recent years, survival has also improved. Chemotherapy has made a substantial impact on this disease and now is used in patients with advanced or metastatic disease as well as in select patients with high-risk muscle invasive disease. While cisplatin remains the most active single antineoplastic agent, several other agents including methotrexate, vinblastine, and Adriamycin (doxorubicin) have important activity. More recently, paclitaxel and gemcitabine have shown promising activity in bladder cancer. Multidrug combination therapy has provided more frequent and durable responses than single agent therapy. Regimens containing cisplatin and methotrexate have been shown to be most effective in the treatment of advanced disease. Adjuvant chemotherapy regimes typically have included cisplatin or cisplatin and methotrexate combinations. However, studies have been limited and further prospective trials are required to determine the role of adjuvant chemotherapy. Multiple studies have investigated neoadjuvant chemotherapy with cisplatin and methotrexate combinations or anthracycline-based regimens, but study results are mixed. Further trials will be required to define the role of neoadjuvant chemotherapy in bladder cancer.
尽管近年来膀胱癌的发病率有所上升，但生存率也有所提高。化疗对这种疾病产生了重大影响，现在用于晚期或转移性疾病患者以及部分高危肌肉浸润性疾病患者。虽然顺铂仍然是最有效的单一抗肿瘤药物，但包括甲氨蝶呤、长春碱和阿霉素（多柔比星）在内的其他几种药物也具有重要活性。最近，紫杉醇和吉西他滨在膀胱癌中显示出有前景的活性。多药联合治疗比单药治疗产生更频繁和持久的反应。含顺铂和甲氨蝶呤的方案已被证明在晚期疾病治疗中最有效。辅助化疗方案通常包括顺铂或顺铂与甲氨蝶呤的联合。然而，研究有限，需要进一步的前瞻性试验来确定辅助化疗的作用。多项研究调查了顺铂与甲氨蝶呤联合或基于蒽环类药物方案的新辅助化疗，但研究结果不一。需要进一步试验来明确新辅助化疗在膀胱癌中的作用。
