Zusammenfassung
Der demographische Wandel unserer Gesellschaft mit zunehmend älteren Patienten und deren steigender Komorbidität führt dazu, dass die operative Behandlung des invasiven Harnblasenkarzinoms älterer Patienten zunehmend an Bedeutung gewinnt. Angesichts dieser Entwicklung sollten der Stellenwert und die Indikation konservativer bzw. wenig invasiver Therapieansätze immer wieder neu hinterfragt werden. Die radikale Zystektomie unter kurativer Zielsetzung ist weiterhin Goldstandard der Behandlung des invasiven High-grade-Karzinoms. Jedoch ist nicht jeder Patient hierfür geeignet oder er steht einer solchen Operation ablehnend gegenüber. Aus diesem Grund sollten dieser Gruppe von Patienten alternative Therapieansätze, ob in kurativer oder palliativer Zielsetzung, einschließlich Organ- und Funktionserhalt der Harnblase, angeboten werden können. Hierbei kommen die transurethrale Blasentumorresektion (TUR-B), die offene Blasenteilresektion, die Chemotherapie (intravesikal – systemisch), die lokale Bestrahlung und minimal-invasive interventionelle Therapien allein oder in Kombination in Frage. Ziel ist es, aufgrund einer geringeren physischen und psychischen Belastung v. a. eine schnelle Rekonvaleszenz der Patienten zu erreichen und die Lebensqualität zu erhalten. Aus onkologischer Sicht müssen diese Therapieansätze jedoch kritisch betrachtet werden, da sie vielleicht nur zu einem vorübergehenden Stillstand der Erkrankung oder zur Beseitigung von Symptomen führen. Dennoch zeigen die Langzeitergebnisse, dass einem Teil der Patienten mit einem High-grade-Karzinom der Harnblase bei richtiger Indikation eine Kuration als Ziel einer multimodalen Therapie mit Blasenerhalt in Aussicht gestellt werden kann.
Abstract
The demographic changes of our society, with an increasing number of elderly patients and higher comorbidity, leads to the fact that managing transitional cell carcinoma (TCC) in the elderly is becoming increasingly more important. Thus, the value and indication of conservative or less invasive treatment approaches have to be continuously re-evaluated. The gold standard of treatment for invasive high grade TCC is radical cystectomy with curative intent. However, not each and every patient is suitable for this procedure or the operation is rejected. Thus, alternative treatment options (curative or palliative) including bladder sparing approaches should be offered to this group of patients. These include transurethral resection (TUR-B), open partial cystectomy, chemotherapy (intravesical or systemic), local radiation and minimally invasive interventional therapies alone or in combination. A lower physical and mental burden and, more important, a faster convalescence and the maintenance of the quality of life, are the major aims of these strategies. From an oncologic point of view these concepts have to be viewed with caution, since they may only lead to a temporarily stable disease or the elimination of symptoms. However, long-term follow-up demonstrates that with the correct indication for a multi-modal treatment, a subset of patients with high grade TCC of the bladder may be cured when implementing a bladder sparing approach.
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Goebell, P., Legal, W., Weiss, C. et al. Multimodale Therapien zum Blasenerhalt bei High-grade-Blasentumoren. Urologe 47, 838–845 (2008). https://doi.org/10.1007/s00120-008-1715-4
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DOI: https://doi.org/10.1007/s00120-008-1715-4