推动发展:放射治疗在非肌层侵袭性膀胱癌中的作用。
Pushing the Envelope: The Role of Radiation Therapy in Non-muscle-Invasive Bladder Cancer.
发表日期:2023 Jan
作者:
Sri Harsha Kombathula, Peter Hoskin
来源:
SEMINARS IN RADIATION ONCOLOGY
摘要:
非肌层侵犯膀胱癌(NMIBC)的治疗标准是经尿道切除后,根据风险分层使用膀胱内免疫治疗或化疗,并对于多发性、复发性和高级别的疾病,采取根治性膀胱切除,具有高的治愈率。类似于肌层侵犯膀胱癌(MIBC)的三联疗法方法的膀胱保留方法尚未得到充分探索,但可用数据表明,NMIBC 是一种放疗敏感的恶性肿瘤,且在一部分患者中可以进行膀胱保留。联合化疗、低氧敏感性、高温和免疫疗法等综合疗法均已被证明是有效的。不幸的是,可用数据质量较差。虽然有许多 NMIBC 进展的潜在预后生物标志物,但在临床使用中没有出现并且没有预测非手术治疗反应的生物标志物。这将是未来大规模研究中评估多模式安排中放疗在 NMIBC 膀胱保留中确切作用的重要组成部分。版权所有©2022。Elsevier Inc. 发布。
The standard of care for non-muscle-invasive bladder cancer (NMIBC) is transurethral resection followed by risk stratified use of intravesical immune- or chemotherapy and for multifocal, recurrent and high grade disease, radical cystectomy with high rates of cure. Bladder preservation analogous to the trimodality therapy approach in muscle-invasive bladder cancer (MIBC) has not been adequately explored but the available data suggests that NMIBC is a radioresponsive malignancy and that in a proportion of patients bladder preservation would be possible. Combination modality with chemotherapy, hypoxia sensitisation, hyperthermia and immunotherapy are all approaches which have been shown effective. Unfortunately the quality of the available data is poor. Although there are many putative prognostic biomarkers for progression in NMIBC none have emerged in clinical use and there are none predictive for response to non-surgical treatment. This would be an important component of future large scale studies to evaluate the precise role of radiotherapy within a multimodality schedule for bladder reservation in NMIBC.Copyright © 2022. Published by Elsevier Inc.