Allgemeines
Operation
blasenerhaltende Therapie
| Study (ref) | No. of patients | Strahlentherapie | 2a-OS | 3a-OS | 5a-OS | 10a-OS | 3a-DSS | 5a-DSS | 10a-DSS | 2a-Blasenerhalt | 3a-Blasenerhalt | 5a-Blasenerhalt | 10a-Blasenerhalt |
| Efstathiou et al (3) | 190 | Conventional | - | - | 52% | 35% | - | 64% | 59% | - | - | 80% | - |
| Rödel et al (4) | 326 | Conventional | - | - | 45% | 29% | - | 56% | 42% | - | - | - | 64% |
| Mak et al (5) | 468 | Conventional | - | - | 57% | 36% | - | 71% | 65% | - | - | 80% | - |
| Huddart et al (6) | 108-Standard whole-bladder RT arm | 3DCRT | - | - | 38% | - | - | - | - | 89,8% | - | - | - |
| 111-Reduced high-dose volume RT arm | - | - | 44% | - | - | - | - | 88,3% | - | - | - | ||
| Chung et al (7) | 340 | Conventional | - | - | 32% | 19% | - | 42% | 35% | - | - | 87% | - |
| Baxter et al (8) | 50 | 3DCRT | - | - | 30% | 17% | - | 31% | 27% | - | - | 60% | - |
| Lee et al (9) | 70 | 3DCRT followed by IMRT for tumor bed boost | - | - | 50,8 | - | - | 67,3% | - | - | - | 61,7% | - |
| Hoskin et al (10) | 163-RT - alone arm | 3DCRT | - | 46% | - | - | 43% | - | - | - | - | - | - |
| 164-RT + CON arm | - | 59% | - | - | 54 | - | - | - | - | - | - | ||
| Turgeon et al (11) | 24 | IMRT | - | 61% | - | - | 71% | - | - | - | 75% | - | - |
| Meijer et al (12) | 20 | Adaptive RT | 50% | - | - | - | - | - | - | 90% | - | - | - |
| Present study (13) | 44 | Adaptive RT | - | 67% | - | - | 73% | - | - | - | 83% | - | - |
RTOG = Radiation Therapy Oncology Group
Cystektomie versus Blasenerhalt (22)
2005-2017
Propensity - Score - Matching (PSM) mit Logistischer Regression, 3:1 Matching
Muskelinvasives Blasenkarzinom klinisch T2-T4N0M0
Patienten, die für beide Therapiearme geeignet wären
keine oder einseitige Hydronephrose
solitäre Tumouren bis 7 cm
kein extensives oder multifokales CA i.s.
Sinai Health Foundation, Princess Margaret Cancer Foundation, Massachusetts General Hospital
| Therapie | Radikale Zystektomie | Trimodale Therapie | Bemerkungen |
| Patienten | 440 | 282 | PSM-Analysis: 837 Zystektomie |
| Alter | 71,4 | 71,6 | |
| Geschlecht | 75% männlich | 76% männlich | |
| Hydronephrose | 12% | 10% | |
| Chemotherapie | 59% | 56% | |
| Follow up | 4,38 a | 4,88 a | |
| 5a-DMFS | 74% | 75% | PSM: 74% versus 74% |
| 5a-CSS | 81% | 84% | |
| 5a-DFS | 73% | 74% | |
| OS | 66% | 73% | HR 0,70; 95%-CI 0,53-0,92; p=0·010; PSM: 72%; 69-75 vs 77%; 72-81; HR 0,75; 0,58-0,97; p=0,0078 |
Salvage - Zystektomie: 38 (13%)
pT2: 28%
pT3-4: 44%
N+: 26%
entfernte LKs: 39
positiver Schnittrand: 1%
perioperative Mortalität: 2,5%
Teil von
Quellen
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Critical analysis of bladder sparing with trimodal therapy in muscle-invasive bladder cancer: a systematic review.
Eur Urol 2014;66:120-37.doi: 10.1016/j.eururo.2014.02.038
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Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: The MGH experience.
Eur Urol 2012;61:705-74
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Trimodality bladder-sparing approach without neoadjuvant chemotherapy for node-negative localized muscle-invasive urinary bladder cancer resulted in comparable cystectomy-free survival.
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J Clin Oncol 2010;28:4912-4918
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12. Meijer GJ, Van Der Toorn PP, Bal M, et al.:
High precision bladder cancer irradiation by integrating a library planning procedure of 6 prospectively generated SIB IMRT plans with image guidance using lipiodol markers.
Radiother Oncol 2012;105:174-179
13.) Murthy V, et al.:
Clinical Outcomes With Dose-Escalated Adaptive Radiation Therapy for Urinary Bladder Cancer: A Prospective Study.
Int J Radiation Oncol Biol Phys 2016;94,60-66
http://dx.doi.org/10.1016/j.ijrobp.2015.09.010
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Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer.
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Management of superficial recurrences in an irradiated bladder after combined- modality organ-preserving therapy.
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Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the national cancer data base.
Eur Urol 2006;63:823–829
18.) Efstathiou JA, Spiegel DY, Shipley WU et al.:
Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience.
Eur Urol 2012;61:705–74
19.) Shipley WU, Kaufman DS, Zehr E et al.:
Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer.
Urology 2002;60:62–67
20.) Krause FS, Walter B, Ott OJ et al.:
15-year survival rates after transurethral resection and radiochemotherapy or radiation in bladder cancer treatment.
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Organ-sparing treatment of advanced bladder cancer: a 10-year experience.
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22.) Zlotta A R, et al.:
Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis.
Lancet Oncol 2023;24(6):669-681.
PMID: 37187202
DOI: 10.1016/S1470-2045(23)00170-5
