Author/Editor		Čufer, Tanja
Title		Combined modality treatment with organ preservation in invasive bladder cancer
Translated title		Kombinirano zdravljenje raka sečnega mehurja z možnostjo ohranitve organa
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 34, št. 1
Publication year		2000
Volume		str. 21-5
Language		eng
Abstract		Background. The standard treatment for muscle-invasive bladder cancer is still radical cystectomy. However despite mutilating surgery half of the patients eventually develop metastatic disease and subsequently die of the disease. In view of these problems, a bladder-sparing approach using multi-modality treatment with transurethral resection (TUR), irradiation and chemotherapy has been tested in this disease. So far, the results published by five groups, showed that the survival rates of patients treated by multi-modality therapy with a bladder sparing approach, based on the response to initial TUR and chemotherapy or chemoradiotherapy, are comparable to cystectomy series, while also offering a 60% to 70% chance of maintaining a functioning bladder. The probability of survival with bladder preserved was found to be around 40% at 5-years. The best predictor of successful multi-modality treatment with bladder preservation seems to be a complete response to initial therapy and a close cystoscopic surveillance is obligatory to allow for cystectomy at earliest opportunity, if necessary. Conclusions. Multimodality treatment with selective bladder preservation offers a chance for long term cure and survival equal to radical cystectomy in muscle invasive bladder cancer, while also offering a chance of maintaining a normally functioning bladder. It is expected, that the identification of biological factors with a predictive value for successful chemoradiation will allow for a better selection of patients who could benefit from this treatment in future.
Summary		Izhodišča. Radikalna cistekomija je še vedno standarden način zdravljenja mišičnoinvazivnega raka sečnega mehurja. Kljub hudi invalidnosti se pri polovici bolnikov v letih po posegu pojavijo oddaljeni zasevki, ki so vzrok njihovi smrti. Zaradi tega smo v zadnjih letih pri teh bolnikih preizkusili kombinirano zdravljenje z možnostjo ohranitve sečnega mehurja. Do sedaj objavljeni izsledki petih skupin kažejo, da je preživetje bolnikov zdravljenih z kombinacijo transuretralne resekcije (TUR), kemoterapije in obsevanja ter z ohranitvijo mehurja v primerih doseženega popolnega odgovora na zdravljenje, primerljivo s preživetjem bolnikov zdravljenih s cistekomijo. Ob tem okoli 60 do 70% bolnikov ohrani funkcionalen sečni mehur, petletno preživetje teh bolnikov pa je okoli 40%. Najpomembnejši napovedni dejavnik učinkovitega zdravljenja je popolen odgovor na TUR, kemoterapijo ali kemoradioterapijo. Skrben nadzor bolnikov z rednimi cistoskopskimi pregledi pa omogoča takojšnjo rešitveno cistektomijo. Zaključki. Kombinirano zdravljenje raka sečnega mehurja z ohranitvijo organa omogoča pri določenih bolnikih podobno stopnjo ozdravitve in preživetja kot radikalna cistektomija, ob enem pa omogoča tudi ohranitev sečnega mehurja in njegove funkcije. Pričakujemo, da bo na podlagi bioloških dejavnikov v prihodnosti mogoče v naprej izbrati bolnike z večjo verjetnostjo odgovora na kemoradioterapijo, kar bo še izboljšalo rezultate kombiniranega zdravljenja in omogočilo ohranitev sečnega mehurja več bolnikom.
Descriptors		BLADDER NEOPLASMS COMBINED MODALITY THERAPY CYSTECTOMY SURVIVAL ANALYSIS