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Perioperative Chemotherapie des Harnblasenkarzinoms

Neoadjuvante, induktive und adjuvante Strategien

Perioperative chemotherapy of bladder cancer

Neoadjuvant, inductive and adjuvant strategies

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Etwa 16.000 Menschen erkranken jährlich in Deutschland an einem muskelinvasiven Harnblasenkarzinom. Standardtherapie ist dabei die radikale Zystektomie mit regionaler Lymphadenektomie. Innerhalb der ersten 2 Jahre nach erfolgter Operation erleiden bis zu 50 % der Patienten mit einem initial nicht metastasiertem Tumorstadium T2–T4a Lymphknotenbefall und/oder Fernmetastasen.

Methode

Recherche und Analyse aktueller Literatur.

Ergebnisse

Zur Eliminierung möglicher Mikrometastasen wird heute der Einsatz perioperativer Therapiekonzepte in Form einer neoadjuvanten, induktiven oder adjuvanten Chemotherapie empfohlen. Obwohl der Nutzen einer perioperativen Chemotherapie mit einer Verbesserung der Überlebensrate durch klinische Studien und Metaanalysen klar belegt ist, findet das Verfahren in Europa noch immer nur eine geringe Akzeptanz. Neben der aktuellen Datenlage werden die Vor- und Nachteile der verschiedenen Modalitäten dargestellt und diskutiert.

Abstract

Background

Every year approximately 16,000 patients are diagnosed with muscle-invasive bladder cancer in Germany. The standard procedure in these patients is radical cystectomy with regional pelvic lymphadenectomy. Within the first 2 years after resection up to 50% of patients initially with non-metastatic tumor stages T2–T4a will relapse with lymph node involvement and/or visceral metastases.

Methods

Research and analysis of the current literature.

Results

To eliminate potential micrometastases the use of perioperative therapeutic concepts in the form of neoadjuvant, inductive and adjuvant chemotherapy is strongly recommended. Despite positive results and high-level evidence from several randomized trials and meta-analyses showing an improved overall survival in favour of bladder cancer patients treated with perioperative chemotherapy, the procedure is currently still underused in Europe. In this review the current data and arguments for and against the various modalities are discussed.

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Authors and Affiliations

  1. Klinik für Urologie, Bereich konservative urologische Onkologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40255, Düsseldorf, Deutschland

    Anja Lorch

  2. Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Axel S. Merseburger

  3. Klinik für Urologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland

    Carsten-Henning Ohlmann

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  1. Anja Lorch
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Correspondence to Anja Lorch.

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Interessenkonflikt

A. Lorch: Novartis, AstraZeneca, MSD, BMS, Novartis, Roche, Ipsen; A.S. Merseburger: BMS, Merck/MSD, Roche, Pfizer, Janssen, Astellas, Astra Zeneca, Ipsen, Takeda; C.-H. Ohlmann: Pierre Fabre, BMS, Roche, MSD

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Lorch, A., Merseburger, A.S. & Ohlmann, CH. Perioperative Chemotherapie des Harnblasenkarzinoms. Onkologe 24, 48–54 (2018). https://doi.org/10.1007/s00761-017-0303-x

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