Treatment options for high-risk T1 bladder cancer: status quo and future perspectives of radiochemotherapy.
Strahlenther Onkol
; 184(9): 443-9, 2008 Sep.
Article
em En
| MEDLINE
| ID: mdl-19016022
ABSTRACT
PURPOSE:
To review the standards and new developments in diagnosis and management of high-risk T1 bladder cancer with emphasis on the role of radiotherapy (RT) and radiochemotherapy (RCT). MATERIAL ANDMETHODS:
A systematic review of the literature on developments in diagnosis and management of high-risk T1 bladder cancer was performed.RESULTS:
First transurethral resection (TUR), as radical as safely possible, supported by fluorescence cystoscopy, shows higher detection and decreased recurrence rates. An immediate single postoperative instillation with a chemotherapeutic drug reduces the relative risk of recurrence by 40%. A second TUR is recommended to assess residual tumor. For adjuvant intravesical therapy, bacille Calmette-Guérin (BCG) demonstrated the highest efficacy. Early cystectomy should be reserved for selected patients. A recent phase III trial comparing RT versus conservative treatment in T1 G3 tumors could not show any advantage for RT. Data from Erlangen, Germany, using combined RCT in 80% of the patients, compare favorably with most of the contemporary BCG series.CONCLUSION:
Results of intravesical therapy are still unsatisfying and early cystectomy is associated with morbidity and mortality. RT alone proved not superior to other conservative treatment strategies. However, data on RCT are promising and demonstrate an alternative to intravesical therapy and radical cystectomy.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Bexiga Urinária
/
Carcinoma de Células de Transição
/
Cistectomia
/
Cistoscopia
Tipo de estudo:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Strahlenther Onkol
Assunto da revista:
NEOPLASIAS
/
RADIOTERAPIA
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Alemanha