浸润性膀胱癌保留膀胱的治疗课件

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)TNMstagingclassificationfr浸润性肿瘤(T2-4aN0-xM0)Indicationsforcystectomy肌层浸润性肿瘤♂♀Donotdelaycystectomymorethan3monthssinceitincreasestheriskofprogressionandcancerspecificdeath.ChangSS,etal.Delayingradicalcystectomyformuscleinvasivebladdercancerresultsinworsepathologicalstage.JUrol2003;170:1085浸润性肿瘤(T2-4aN0-xM0)Indicatio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%

保留膀胱的治疗保留膀胱手术

单纯TURBT

TURBT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单纯TURBT目前保留膀胱的治疗方法有以下几种CUAg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。CUAguidelines2014推荐意见：CUAguidelines2014EAUguidelines2015EAUguidelines2015EAUguidelines2015EAUguidelines2015BLADDER-SPARINGTREATMENTSFORLOCALISEDDISEASEFeasibilityofRadicalTransurethralResectionasMonotherapyforSelectedPatientsWithMuscleInvasiveBladderCancerEduardoSolsona,etal.JUrol.,2010,184:475Conclusions:Radicaltransurethralbladdertumorresectionisareliabletherapeuticapproachforpatientswithmuscleinvasivebladdercanceraftercompletetumorresectionandwithnegativebiopsiesofthetumorbed.BLADDER-SPARINGTREATMENTSFOR浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件Five-,10-,and15-yrcumulativeDSSrateswere64%,59%,and57%,respectivelyFive-,10-,and15-yrcumulativeOSrateswere52%,35%,and22%,respectivelyFive-,10-,and15-yrcumulatiT2,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%T2,Five-,10-,and15-yr74%浸润性膀胱癌保留膀胱的治疗课件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.Outcomes72%ofallpatients(78%with浸润性膀胱癌保留膀胱的治疗课件与根治性膀胱全切相比生存率相当与根治性膀胱全切相比生存率相当CMTachievesaCRandpreservesthenativebladderin>70%ofpatients

whileofferinglong-termsurvivalratescomparabletocontemporarycystectomyseries.

Theseresultssupportmodern

bladder-sparingtherapyasaprovenalternativefor

selectedpatients.Bladder-sparingtherapyoffersauniqueopportunityforurologicsurgeons,radiationoncologists,andmedicaloncologiststoworkhand-in-handinatrulymultidisciplinaryeffortforthebenefitofpatientswithinvasiveBCa.ConclusionsCMTachievesaCRandpreserve浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件Fig.7.CRand5-yearOSratesinpatientsreceivingneoadjuvantchemotherapy(NADCT+)ornot(NADCT−).Fig.7.CRand5-yearOSrateAgrowingbodyofaccumulateddatasuggeststhatTMT(withpromptcystectomyreservedfortumourrecurrenceornonresponders)leadstoacceptableoutcomesandmaythereforebeconsideredareasonabletreatmentoptioninwell-selectedpatients.TMTcanbediscussednotonlyinpatientsunfitforsurgerybutalsoforthosepatientswhohaveMIBCandarenotwillingtoundergosurgery.ConclusionsAgrowingbodyofaccumulatedTheresultsofthisoverviewseemtoindicatethatTMTisabletoproduceexcellent5-yearOSrates,nomatterhowitisdone(continuousorsplit).Nosignificantdifferencein5-yearOSratescouldbeobservedbetweenthetwotreatmentregimens,althoughthecontinuousmayoffersomeadvantagecomparedtosplittreatmentintermsofhigherCRand,likelylowerSCrates.ConclusionsTheresultsofthisoverviews浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件浸润性膀胱癌保留膀胱的治疗课件From1997–2010,183consecutivepatientswithcT2-4aN0M0bladdercancer(medianage70years,women/men=46/137,T2/3/4a=100/69/14)underwentdebulkingtransurethralresectionfollowedbyLCRT(radiationat40Gytothesmallpelvisconcurrentlywithtwocyclesofi.v.cisplatinat20mg/dayfor5days).From1997–2010,183consecut(i)EssentiallysolitaryMIBCorintravesicallycircumscribedtumours(≈25%orlessofthebladderinarea,excludingthebladderneckandtrigone);(ii)noinvolvementofbladderneckortrigone;and(iii)clinically,noresidualdiseaseorminimalamountsofnon-invasivediseaseintheoriginalMIBCsiteafterLCRT;otherwise,radicalcystectomy(RC)isrecommended.CriteriaforPCinclude:(i)EssentiallysolitaryMIBC•Histologicalexaminationofthe46PCspecimensshowedresidualmuscle-invasivediseaseinthree(7%).•Inthe46PCpatients,neitherMIBC,norpelvicrecurrencewasobserved;5-yearCSSandMRFSrateswereboth100%.•Histologicalexami