Leczenie zachowawcze inwazyjnego naciekającego mięśniówkę właściwą raka pęcherza moczowego

Abstract

Author(s): Jadwiga Nowak-Sadzikowska, Jerzy Jakubowicz

Curative treatment options for invasive bladder cancer include radical cystectomy and therapeutic strategies with bladder preservation. The standard of treatment for muscle-invasive carcinoma of the bladder is radical cystectomy. Combined conservative therapy in selected patients can achieve 5-year survival rates of 50%- 63%, and approximately 75% of surviving patients maintained their bladder. Conservative local treatment – transurethral resection and radiotherapy allows to obtain 5-year survival within 20%-40% range. Many studies have been conducted to improve the results of radiotherapy in treatment of invasive bladder cancer by escalation of total dose, adoption of altered fractionation, reduction in overall treatment time, combining teleradiotherapy with brachytherapy or using radiosensitizers. Low local control and high rate of distant metastases led to systemic chemotherapy being incorporated into local treatment of invasive bladder cancer. A meta-analysis assessing the effect of neodjuvant platinum based combination chemotherapy showed a significant benefit to overall survival. However, the results of the randomized trial comparing radiotherapy and concurrent chemotherapy with or without neoadjuvant chemotherapy reported no differences in terms of treatment results. Also adjuvant chemotherapy after the completion of the chemoradiotherapy in patients with invasive bladder cancer doesn’t improve overall survival compared with chemoradiotherapy. The presented data suggested that prolongation of treatment time could have an unfavourable effect. Chemotherapeutic agents such as cisplatin, gemcytabine, 5Fu, paclitaxel are usually used with concurrent radiation due to their cytotoxic and radiosensitizing properties. Also targeted therapy has been introduced to organ-sparing treatment of invasive bladder cancer. Selection of patients for bladder preservation, the optimal management of delivering chemotherapy (sequentially or concurrently), chemotherapy regiments, altered radiotherapy fractionation and technique, the toxicity of treatment, the effect of therapy on quality of life, remain to be determined.

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