Invasive bladder cancer: Treatment strategies using transurethral surgery, chemotherapy and radiation therapy with selection for bladder conservation
| Autor: | Donald S. Kaufman, Alex F. Althausen, Niall M. Heney, William U. Shipley, Anthony L. Zietman |
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| Rok vydání: | 1997 |
| Předmět: |
Cancer Research
medicine.medical_specialty medicine.medical_treatment Cystectomy Humans Medicine Combined Modality Therapy Neoplasm Invasiveness Radiology Nuclear Medicine and imaging Survival rate Neoplasm Staging Radiation Urinary bladder Bladder cancer business.industry Standard treatment Radiotherapy Dosage medicine.disease Primary tumor Surgery Radiation therapy medicine.anatomical_structure Urinary Bladder Neoplasms Oncology Radiology business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 39:937-943 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/s0360-3016(97)00461-6 |
| Popis: | Purpose Combined modality therapy has become the standard oncologic approach to achieve organ preservation in many malignancies. Methods and materials Although radical cystectomy has been considered as standard treatment for invasive bladder carcinoma in the United States, good results have been recently reported from several centers using multimodality treatment, particularly in patients with clinical T2 and T3a disease who do not have a ureter obstructed by tumor. Results The components of the combined treatment are usually transurethral resection of the bladder tumor (TURBT) followed by concurrent chemotherapy and radiation therapy. Following an induction course of therapy a histologic response is evaluated by cystoscopy and rebiopsy. Clinical "complete responders" (tumor site rebiopsy negative and urine cytology with no tumor cells present) continue with a consolidation course of concurrent chemotherapy and radiation. Those patients not achieving a clinical complete response are recommended to have an immediate cystectomy. Individually the local monotherapies of radiation, TURBT, or multidrug chemotherapy each achieve a local control rate of the primary tumor of from 20 to 40%. When these are combined, clinical complete response rates of from 65 to 80% can be achieved. Seventy-five to 85% of the clinical complete responders will remain with bladders free of recurrence of an invasive tumor. Conclusions Bladder conservation trials using combined modality treatment approaches with selection for organ conservation by response of the tumor to initial treatment report overall 5-year survival rates of approximately 50%, and a 40-45% 5-year survival rate with the bladder intact. These modern multimodality bladder conservation approaches offer survival rates similar to radical cystectomy for patients of similar clinical stage and age. Bladder-conserving therapy should be offered to patients with invasive bladder carcinoma as a realistic alternative to radical cystectomy by experienced multimodality teams of urologic oncologists. |
| Databáze: | OpenAIRE |
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