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肌层浸润性膀胱癌保留膀胱的治疗策略

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肌层浸润性膀胱癌保留膀胱的治疗策略肌层浸润性膀胱癌保留膀胱的治疗策略TNMstagingclassificationfromUICC非浸润性膀胱癌(表浅性)Ta,T1,Tis——局限于固有层内浸润性膀胱癌T2-T4——肿瘤侵犯至肌层以上组织病理学—分期TNMstagingclassificationfromUICC2009(7th)浸润性肿瘤(T2-4aN0-xM0)Indicationsforcystectomy肌层浸润性肿瘤♂♀Donotdelaycystectomymorethan3monthssinceitincreasestheris...

肌层浸润性膀胱癌保留膀胱的治疗策略
肌层浸润性膀胱癌保留膀胱的治疗策略TNMstagingclassificationfromUICC非浸润性膀胱癌( 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 浅性)Ta,T1,Tis——局限于固有层内浸润性膀胱癌T2-T4——肿瘤侵犯至肌层以上组织病理学—分期TNMstagingclassificationfromUICC2009(7th)浸润性肿瘤(T2-4aN0-xM0)Indicationsforcystectomy肌层浸润性肿瘤♂♀Donotdelaycystectomymorethan3monthssinceitincreasestheriskofprogressionandcancerspecificdeath.ChangSS,etal.Delayingradicalcystectomyformuscleinvasivebladdercancerresultsinworsepathologicalstage.JUrol2003;170:1085保留膀胱的治疗保留膀胱手术——TUR:T2a?——部分切除无手术条件(全身状态、尿道狭窄、憩室等)强调综合治疗5年总生存率45%-73%10年总生存率29%-49%单纯TURBTTURBT联合外放疗TURBT联合化疗TURBT联合放、化疗(MultimodalityorTrimodality)膀胱部分切除联合化疗目前保留膀胱的治疗方法有以下几种CUAguidelines2014推荐意见:特殊情况下需选择保留膀胱的治疗方法时,须与患者充分沟通并告知风险,应辅以联合放、化疗,并密切随访。CUAguidelines2014EAUguidelines2015EAUguidelines2015BLADDER-SPARINGTREATMENTSFORLOCALISEDDISEASEFeasibilityofRadicalTransurethralResectionasMonotherapyforSelectedPatientsWithMuscleInvasiveBladderCancerEduardoSolsona,etal.JUrol.,2010,184:475Conclusions:Radicaltransurethralbladdertumorresectionisareliabletherapeuticapproachforpatientswithmuscleinvasivebladdercanceraftercompletetumorresectionandwithnegativebiopsiesofthetumorbed.Five-,10-,and15-yrcumulativeDSSrateswere64%,59%,and57%,respectivelyFive-,10-,and15-yrcumulativeOSrateswere52%,35%,and22%,respectivelyT2,Five-,10-,and15-yr74%,67%,and63%T3–4Five-,10-,and15-yr53%,49%,and49%,T2,Five-,10-,and15-yr61%,43%,and28%T3–4Five-,10-,and15-yr41%,27%,and16%72%ofallpatients(78%withT2disease)achievedCRtoinductionchemoradiation.AmongpatientsachievingCR,10-yrratesofnoninvasive,invasive,pelvic(nodalorsidewall),anddistantrecurrenceswere29%,16%,11%,and32%,respectively.Onehundredtwopatients(29%)ultimatelyrequiredacystectomy—60(17%)immediatelyforlessthanCRand42(12%)inapromptsalvagefashionforrecurrentinvasivetumorsidentifiedduringfollow-upwithclosecystoscopicsurveillance.Mediantimetocystectomyinthesalvagegroupwas1.1yr(95%CI,0.75–1.5).Nopatientrequiredcystectomyresultingfromtreatmentrelatedtoxicity.Outcomes与根治性膀胱全切相比生存率相当CMTachievesaCRandpreservesthenativebladderin>70%ofpatientswhileofferinglong-termsurvivalratescomparabletocontemporarycystectomyseries.Theseresultssupportmodernbladder-sparingtherapyasaprovenalternativeforselectedpatients.Bladder-sparingtherapyoffersauniqueopportunityforurologicsurgeons,radiationoncologists,andmedicaloncologiststoworkhand-in-handinatrulymultidisciplinaryeffortforthebenefitofpatientswithinvasiveBCa.ConclusionsFig.7.CRand5-yearOSratesinpatientsreceivingneoadjuvantchemotherapy(NADCT+)ornot(NADCT−).AgrowingbodyofaccumulateddatasuggeststhatTMT(withpromptcystectomyreservedfortumourrecurrenceornonresponders)leadstoacceptableoutcomesandmaythereforebeconsideredareasonabletreatmentoptioninwell-selectedpatients.TMTcanbediscussednotonlyinpatientsunfitforsurgerybutalsoforthosepatientswhohaveMIBCandarenotwillingtoundergosurgery.ConclusionsTheresultsofthisoverviewseemtoindicatethatTMTisabletoproduceexcellent5-yearOSrates,nomatterhowitisdone(continuousorsplit).Nosignificantdifferencein5-yearOSratescouldbeobservedbetweenthetwotreatmentregimens,althoughthecontinuousmayoffersomeadvantagecomparedtosplittreatmentintermsofhigherCRand,likelylowerSCrates.ConclusionsFrom1997–2010,183consecutivepatientswithcT2-4aN0M0bladdercancer(medianage70years,women/men=46/137,T2/3/4a=100/69/14)underwentdebulkingtransurethralresectionfollowedbyLCRT(radiationat40Gytothesmallpelvisconcurrentlywithtwocyclesofi.v.cisplatinat20mg/dayfor5days).(i)EssentiallysolitaryMIBCorintravesicallycircumscribedtumours(≈25%orlessofthebladderinarea,excludingthebladderneckandtrigone);(ii)noinvolvementofbladderneckortrigone;and(iii)clinically,noresidualdiseaseorminimalamountsofnon-invasivediseaseintheoriginalMIBCsiteafterLCRT;otherwise,radicalcystectomy(RC)isrecommended.CriteriaforPCinclude:•Histologicalexaminationofthe46PCspecimensshowedresidualmuscle-invasivediseaseinthree(7%).•Inthe46PCpatients,neitherMIBC,norpelvicrecurrencewasobserved;5-yearCSSandMRFSrateswereboth100%.•Inthecurrentselectivebladder-sparingprotocol,one-thirdofMIBCpatientsmetthePCcriteria;whenpatientsfromthisgroupunderwentPCwithpelviclymphnodedissection,theironcologicaloutcomeswereexcellent.•ConsolidativePCpotentiallyreducesMIBCrecurrenceinthepreservedbladder,eventuallyimprovingsurvivalinproperlyselectedMIBCpatients.Conclusions保留膀胱治疗是肌层浸润性膀胱癌可选择的手段对选择性患者可以达到与根治手术相似的结果强调手术结合放化疗的联合治疗选择部分切除的指证有待进一步明确应充分患者告知并密切随访小结
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