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Blaassparende behandeling bij spierinvasief blaascarcinoom. De behandeling van de toekomst

  • Blaassparende Behandeling Bij Spierinvasief Blaascarcinoom
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Samenvatting

De standaardbehandeling bij een patiënt met een spierinvasief blaascarcinoom bestaat nog steeds uit een radicale cystectomie met urinedeviatie. Voor radiotherapie kwamen alleen patiënten in aanmerking bij wie de tumor op medische gronden niet operabel of resectabel was.

Een recent omvangrijk gerandomiseerd onderzoek toonde aan dat chemotherapie gelijktijdig aan de bestraling een significante winst in locoregionale controle en survival opleverde. De invasief locoregionale ziektevrije overleving benaderde die van cystectomieseries. Daarnaast hebben zich de laatste jaren meerdere technische ontwikkelingen voorgedaan, die hebben geleid tot nauwkeuriger bestraling, waardoor bij de meerderheid van de patiënten een goed functionerende blaas behouden kon blijven. Inwendige bestraling is al een langer bestaande blaassparende behandeloptie voor kleine blaastumoren. Een recente Nederlandse studie bij meer dan 1000 patiënten bevestigde nog eens de goede lokale tumorcontrole met behoud van adequate blaasfunctie die met inwendige bestraling bereikt kan worden. Een blaassparende behandeling met radio(chemo)therapie lijkt daarmee een goed alternatief te zijn voor een radicale cystectomie en dient met de patiënt besproken te worden.

Summary

Bladder conserving approach as alternative treatment of muscle invasive bladder cancer

A radical cystectomy is the standard treatment for muscle-invasive bladder cancer and radiotherapy was preserved for unfit or elderly patients. Recently important improvements have been reported on bladder conserving treatment with external radiotherapy.

In April 2012, a randomised phase III study has been published, demonstrating that concurrent radiochemotherapy impressively improved loco-regional tumor-free and overall survival compared to radiotherapy only. The results of this concomitant treatment approach the results of radical surgery. Furthermore, accuracy of external beam radiotherapy has technically improved, resulting in increased radiation doses in these moving tumor(-areas) and decreased doses in the healthy surrounding tissues.

Dutch radiotherapy departments have collected their bladdersparing data in a national database of 1040 selected patients with a solitary bladder cancer, pT1-3, maximal diameter 4 cm treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%. A bladder conserving approach should be seriously considered as treatment alternative for radical surgery.

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  1. radiotherapeut-oncoloog, Academisch Medisch Centrum, Amsterdam, The Netherlands

    M.C.C.M. Hulshof

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Hulshof, M. Blaassparende behandeling bij spierinvasief blaascarcinoom. De behandeling van de toekomst. Tijdschrift voor Urologie 3, 42–46 (2013). https://doi.org/10.1007/s13629-013-0011-2

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  • DOI: https://doi.org/10.1007/s13629-013-0011-2

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