Skip to main content
SpringerLink
Log in

Radiochemotherapie beim Harnblasenkarzinom

Ein Update

Radiochemotherapy for invasive bladder cancer

An update

  • Leitthema
  • Published:
Der Urologe Aims and scope Submit manuscript

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.

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).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Aluwini S, van Rooij PH, Kirkels WJ et al (2014) Bladder function preservation with brachytherapy, external beam radiation therapy, and limited surgery in bladder cancer patients: long-term results. Int J Radiat Oncol Biol Phys 88:611–617

    Article  PubMed  Google Scholar 

  2. Caffo O, Fellin G, Graffer U, Luciani L (1996) Assessment of quality of life after cystectomy or conservative therapy for patients with infiltrating bladder carcinoma. A survey by a self-administered questionnaire. Cancer 78:1089–1097

    Article  PubMed  CAS  Google Scholar 

  3. Coppin CM, Gospodarowicz MK, James K et al (1996) Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. The National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 14:2901–2907

    Article  PubMed  CAS  Google Scholar 

  4. Danesi DT, Arcangeli G, Cruciani E et al (2004) Conservative treatment of invasive bladder carcinoma by transurethral resection, protracted intravenous infusion chemotherapy, and hyperfractionated radiotherapy: long term results. Cancer 101:2540–2548

    Article  PubMed  Google Scholar 

  5. Efstathiou JA, Bae K, Shipley WU et al (2009) Late pelvic toxicity after bladder-sparing therapy in patients with invasive bladder cancer: RTOG 89-03, 95-06, 97-06, 99-06. J Clin Oncol 27:4055–4061

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Efstathiou JA, Spiegel DY, Shipley WU et al (2012) Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience. Eur Urol 61:705–711

    Article  PubMed  Google Scholar 

  7. Hagan MP, Winter KA, Kaufman DS et al (2003) RTOG 97-06: initial report of a phase I‑II trial of selective bladder conservation using TURBT, twice-daily accelerated irradiation sensitized with cisplatin, and adjuvant MCV combination chemotherapy. Int J Radiat Oncol Biol Phys 57:665–672

    Article  PubMed  Google Scholar 

  8. Horwich A, Dearnaley D, Huddart R et al (2005) A randomised trial of accelerated radiotherapy for localised invasive bladder cancer. Radiother Oncol 75:34–43

    Article  PubMed  Google Scholar 

  9. Hoskin PJ, Rojas AM, Bentzen SM, Saunders MI (2010) Radiotherapy with concurrent carbogen and nicotinamide in bladder carcinoma. J Clin Oncol 28:4912–4918

    Article  PubMed  Google Scholar 

  10. Housset M, Dufour B, Maulard-Durdux C et al (1997) Concomitant fluorouracil (5-FU)-cisplatin (CDDP) and bifractionated split course radiation therapy for invasive bladder cancer. Proc Am Soc Clin Oncol 16:319a

    Google Scholar 

  11. Huddart RA, Hall E, Lewis R, Birtle A (2010) SPARE Trial Management Group. Life and death of spare (selective bladder preservation against radical excision): reflections on why the spare trial closed. BJU Int 106:753–755

    Article  PubMed  Google Scholar 

  12. James ND, Hussain SA, Hall E et al (2012) Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med 366:1477–1488

    Article  PubMed  CAS  Google Scholar 

  13. Kaufman DS, Winter KA, Shipley WU et al (2000) The initial results in muscle-invading bladder cancer of RTOG 95-06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5‑fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist 5:471–476

    Article  PubMed  CAS  Google Scholar 

  14. Kaufman DS, Winter KA, Shipley WU et al (2009) Phase I‑II RTOG study (99-06) of patients with muscle-invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice-daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology 73:833–837

    Article  PubMed  Google Scholar 

  15. Kulkarni GS, Hermanns T, Wei Y et al (2017) Propensity score analysis of radical cystectomy versus bladder-sparing trimodal therapy in the setting of a multidisciplinary bladder cancer clinic. J Clin Oncol 35:2299–2305

    Article  PubMed  Google Scholar 

  16. Lagrange JL, Bascoul-Mollevi C, Geoffrois L et al (2011) Quality of life assessment after concurrent chemoradiation for invasive bladder cancer: results of a multicenter prospective study (GETUG 97-015). Int J Radiat Oncol Biol Phys 79:172–178

    Article  PubMed  Google Scholar 

  17. Mak RH, Hunt D, Shipley WU et al (2014) Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of Radiation Therapy Oncology Group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol 32:3801–3809

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mitin T, Hunt D, Shipley WU et al (2013) Transurethral surgery and twice-daily radiation plus paclitaxel-cisplatin or fluorouracil-cisplatin with selective bladder preservation and adjuvant chemotherapy for patients with muscle invasive bladder cancer (RTOG 0233): a randomised multicentre phase 2 trial. Lancet Oncol 14:863–872

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Ploussard G, Efstathiou JA, Herr HH et al (2014) Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review. Eur Urol 66:120–137

    Article  PubMed  CAS  Google Scholar 

  20. Ritch CR, Balise R, Prakash NS et al (2017) Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer. BJU Int. https://doi.org/10.1111/bju.14109

    Article  Google Scholar 

  21. Rödel C, Weiss C, Sauer R (2006) Trimodality treatment and selective organ preservation for bladder cancer. J Clin Oncol 24:5536–5544

    Article  PubMed  Google Scholar 

  22. Rödel C, Grabenbauer GG, Kuhn R et al (2002) Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol 20:3061–3071

    Article  PubMed  Google Scholar 

  23. Seisen T, Sun M, Lipsitz SR et al (2017) Comparative effectiveness of trimodal therapy versus radical cystectomy for localized muscle-invasive urothelial carcinoma of the bladder. Eur Urol. https://doi.org/10.1016/j.eururo.2017.03.038

    Article  PubMed  Google Scholar 

  24. Shipley WU, Winter KA, Kaufman DS et al (1998) Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of Radiation Therapy Oncology Group 89-03. J Clin Oncol 16:3576–3583

    Article  PubMed  CAS  Google Scholar 

  25. Tester W, Porter A, Asbell S et al (1993) Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12. Int J Radiat Oncol Biol Phys 25:783–790

    Article  PubMed  CAS  Google Scholar 

  26. Tester W, Caplan R, Heaney J et al (1996) Neoadjuvant combined modality program with selective organ preservation for invasive bladder cancer: results of Radiation Therapy Oncology Group phase II trial 8802. J Clin Oncol 14:119–126

    Article  PubMed  CAS  Google Scholar 

  27. Tunio MA, Hashmi A, Qayyum A et al (2012) Whole-pelvis or bladder-only chemoradiation for lymph node-negative invasive bladder cancer: single-institution experience. Int J Radiat Oncol Biol Phys 82:e457–462

    Article  PubMed  Google Scholar 

  28. Van der Steen-Banasik E, Ploeg M, Witjes JA et al (2009) Brachytherapy versus cystectomy in solitary bladder cancer: a case control, multicentre, East-Netherlands study. Radiother Oncol 93:352–357

    Article  PubMed  Google Scholar 

  29. Vashistha V, Wang H, Mazzone A et al (2017) Radical cystectomy compared to combined modality treatment for muscle-invasive bladder cancer: a systematic review and meta-analysis. Int J Radiat Oncol Biol Phys 97:1002–1020

    Article  PubMed  Google Scholar 

  30. Weiss C, Wittlinger M, Engehausen DG et al (2008) Management of superficial recurrences in an irradiated bladder after combined-modality organ-preserving therapy. Int J Radiat Oncol Biol Phys 70:1502–1506

    Article  PubMed  Google Scholar 

  31. Wittlinger M, Rödel CM, Weiss C et al (2009) Quadrimodal treatment of high-risk T1 and T2 bladder cancer: transurethral tumor resection followed by concurrent radiochemotherapy and regional deep hyperthermia. Radiother Oncol 93:358–363

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Deutschland

    N. Tselis

  2. Wiesbaden, Deutschland

    F. J. Prott

  3. Universitätsklinikum Erlangen, Erlangen, Deutschland

    O. Ott

  4. Klinikum Darmstadt, Darmstadt, Deutschland

    C. Weiss

  5. Universitätsklinikum Frankfurt, Frankfurt, Deutschland

    C. Rödel

Authors
  1. N. Tselis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. J. Prott
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Ott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Rödel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Tselis.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tselis, N., Prott, F.J., Ott, O. et al. Radiochemotherapie beim Harnblasenkarzinom. Urologe 57, 679–685 (2018). https://doi.org/10.1007/s00120-018-0628-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-018-0628-0

Schlüsselwörter

Keywords

Search

Navigation