Der Urologe

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Radiochemotherapie beim Harnblasenkarzinom

Ein Update
  • N. Tselis
  • F. J. Prott
  • O. Ott
  • C. Weiss
  • C. Rödel
Leitthema

Zusammenfassung

Hintergrund

Standardbehandlung des muskelinvasiven Karzinoms ist die Zystektomie mit pelviner Lymphadenektomie. Die primär organerhaltende, multimodale Therapie gilt als Alternative zur radikalen Operation.

Ziel der Arbeit

Konzept und Ergebnisse der multimodalen Therapie, bestehend aus initialer transurethraler Resektion des Blasentumors (TURB), gefolgt von der simultanen Radiochemotherapie (RCT), werden vorgestellt.

Material und Methoden

Auswertung retrospektiver Fallserien und prospektiver Therapieoptimierungsstudien zu primär organerhaltenden Behandlungskonzepten. Komparative Metaanalysen zum Vergleich der Zystektomie mit der trimodalen Behandlung werden vorgestellt.

Ergebnisse

Eine komplette TURB samt Blasenmapping und Tumorgrundbiopsie sollte vor RCT angestrebt werden. Die Radiosensibilisierung sollte mit einer Cisplatin-basierten Chemotherapie oder mit einer Kombination von 5‑Fluorouracil und Mitomycin C erfolgen. Komplette Remissionsraten nach TURB plus RCT werden stadienabhängig bei 60–90 % der Patienten sowie 5‑Jahres-Überlebensraten zwischen 40–75 % mit einem Erhalt der Blase bei ca. 80 % der überlebenden Patienten erreicht.

Schlussfolgerung

Die multimodale Therapie stellt eine Alternative zur radikalen Zystektomie mit kurativer Zielsetzung für Patienten mit muskelinvasivem Harnblasenkarzinom dar. Besonders eignen sich Patienten mit frühen Tumoren (cT2/3N0), bei denen die initiale TURB zur möglichst kompletten Tumorentfernung (R0) führt.

Schlüsselwörter

Zystektomie Lymphadenektomie Organerhalt Resektion, transurethrale Cisplatin 

Radiochemotherapy for invasive bladder cancer

An update

Abstract

Background

The standard treatment for muscle-invasive bladder cancer is radical cystectomy with pelvic lymphadenectomy. Primary organ-preservation by means of multimodal therapy, however, can be a viable alternative to radical surgery.

Objectives

The concept and results of multimodal therapy, consisting of initial transurethral resection of the bladder tumor (TUR-B), followed by simultaneous radiochemotherapy (RCT), are presented.

Materials and methods

Evaluation of retrospective cohorts and prospective therapy optimization studies on organ-preservation treatment regimens. Comparative meta-analyses comparing cystectomy with multimodal treatment are presented.

Results

Complete TUR-B, including bladder mapping and tumor biopsy, should precede simultaneous RCT. Radiosensitization should be cisplatin-based or consist of a combination of 5‑fluorouracil and mitomycin C. Complete response rates after TUR-B plus RCT are generated in 60–90% of patients along with 5‑year survival rates of 40–75% and preservation of the bladder in approximately 80% of surviving patients.

Conclusions

Multimodal therapy by means of TUR-B followed by simultaneous RCT is a viable alternative to radical cystectomy for patients with muscle-invasive urinary bladder carcinoma. Patients with early tumors (cT2/3N0) are particularly suitable in whom initial TUR-B leads to complete tumor resection (R0).

Keywords

Cystectomy Lymphadenectomy Organ preservation Resektion, transurethrale Cisplatin 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

N. Tselis, F.J. Prott, O. Ott, C. Weiss und C. Rödel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • N. Tselis
    • 1
  • F. J. Prott
    • 2
  • O. Ott
    • 3
  • C. Weiss
    • 4
  • C. Rödel
    • 5
  1. 1.Klinik für Strahlentherapie und Onkologie, Universitätsklinikum FrankfurtGoethe Universität FrankfurtFrankfurt/MainDeutschland
  2. 2.WiesbadenDeutschland
  3. 3.Universitätsklinikum ErlangenErlangenDeutschland
  4. 4.Klinikum DarmstadtDarmstadtDeutschland
  5. 5.Universitätsklinikum FrankfurtFrankfurtDeutschland

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